The AAHKS Clinical Research Award: No Evidence for Superior Patient-Reported Outcome Scores After Total Hip Arthroplasty With the Direct Anterior Approach at 1.5 Months Postoperatively, and Through a 5-Year Follow-Up

Abstract

Background: The direct anterior approach to total hip arthroplasty (THA) may result in superior early postoperative patient-reported outcome measures (PROMs). This study compared PROMs between THA patients treated with the direct anterior or posterolateral approach between 1.5 months and 5 years, using literature-derived patient acceptable symptom state (PASS) and minimal clinically important improvement (MCII) thresholds. Methods: A propensity score match of 93 direct anterior patients to 93 posterolateral patients from a multicenter US collaboration (6 centers, 398 patients) was performed. The Harris Hip Score (HHS), the Short-Form 36, and a Numerical Rating Scale for Pain were collected preoperatively, postoperatively (mean days: 47), and at 1, 3, and 5 years. The proportion of patients reaching the HHS PASS, Pain MCII, and Function MCII in the direct anterior and posterolateral groups was compared using binary logistic regressions, controlling for age, gender, body mass index, and Charnley score. Results: Direct anterior patients were less likely to reach the HHS PASS at the postoperative visit (P ¼ .015; odds ratio ¼ 0.454), but not at later visits (P > .082). Direct anterior patients had no difference from posterolateral patients in their tendency to reach the Pain MCII postoperatively or at 1 year (P > .090). The direct anterior patients were less likely to reach the Function MCII at the postoperative visit (P ¼ .011; odds ratio ¼ 0.422), but not at 1 year (P ¼ .958). Conclusion:No evidence was found of superior early postoperative PROM scores in THA patients treated with the direct anterior approach. No PROM differences were found at or beyond 1 year, indicating that patients reach similar final symptom states, regardless of surgical approach.

Patients are Most Interested in Which Hip Arthroplasty Approach? A 15-year Google Trends Analysis

“…Despite its growing popularity and utilization, there is still uncertainty in the orthopedic community as to whether the direct anterior approach is clinically superior to other hip arthroplasty approaches. The arthroplasty literature has previously reported an increased complication rate, lack of clinical superiority, and a steep learning curve as reasons why the direct anterior approach should not necessarily be performed over other common approaches [ [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] ]. Therefore, the rapid increase in patient interest for direct anterior hip arthroplasty procedures is likely unrelated with the reported clinical outcomes associated with this procedure.…”

Good long-term outcomes for Direct Anterior Approach Total Hip Arthroplasty in South Africa

“…27 Although novel PROMs including FJS-12 and PJP are becoming more popular, there are limited studies with which to compare findings along these variables. [27][28][29][30][31][32][33][34][35][36][37][38][39] Although novel PROMs including FJS-12 and PJP are becoming more popular, there are limited studies with which to compare findings along these scales. [27][28][29][30][31][32][33] Our study has included a wide variety of PROMs to serve as a standard to compare existing data and as a baseline for the evolving trends.…”

Patient-reported Outcomes After Primary Total Hip Arthroplasty Are Not Affected by the Sex of the Surgeon: A Register-based Study of 8,383 Procedures in Western Sweden

“…We chose to not include the surgical approach because of previous controversy on whether the surgical approach affects PROs after primary THA. 24,25…”