Elsevier

The Journal of Arthroplasty

Volume 28, Issue 9, October 2013, Pages 1634-1638
The Journal of Arthroplasty

Prospective Randomized Study of Direct Anterior vs Postero-Lateral Approach for Total Hip Arthroplasty

https://doi.org/10.1016/j.arth.2013.01.034Get rights and content

Abstract

Benefits of a direct anterior approach (DAA) versus a posterior-lateral (PA) approach to THA were assessed in a single-surgeon, IRB-approved, prospective, randomized clinical study. Subjects (43 DAA and 44 PA) were evaluated at 6 weeks, and 3, 6 and 12 months. The primary end point was ability to climb stairs normally and walk unlimited at each time point. Secondary end points included assessment by several outcome instruments. DAA subjects performed better during the immediate post-operative period; they had lower VAS pain scores on the first post-operative day, more subjects climbing stairs normally and walking unlimited at 6 weeks, and higher HOOS Symptoms scores at 3 months. There were no significant differences between groups at later time points. Findings confirm previous reports of benefits of DAA versus PA in early post-operative phases.

Section snippets

Methods and Materials

This study reports the results of an IRB-approved prospective, randomized clinical study to evaluate two different surgical techniques, the direct anterior approach (DAA) and the postero-lateral approach (PA). The study was conducted at a single center by one surgeon, who is a fellowship-trained joint surgeon with extensive prior experience in both techniques. Patients were randomized to one of two study groups, DAA or PA, using a randomization schedule that utilized blocks to ensure

Results

Demographic data were comparable for the DAA and PA groups except the DAA group had significantly more males (P = 0.0313, Table 1). Pre-operative evaluation revealed a significantly higher Harris Hip Pain score for the DAA group (P = 0.0347, Table 1). Controlling for gender and preoperative Harris Hip Pain score did not change the significance of any variables at any visit. Surgery time was significantly longer (P < 0.0001) with more blood loss (P < 0.0001) and a larger incision (P < 0.0001) for the DAA

Discussion

Early post-operative data, one day postoperative VAS Pain Score (4.0 vs 4.5) and walking distance on the day of surgery and one and two days post-operative were significantly better for the DAA group, suggesting that the anterior approach, results in less pain and better mobility in the period immediately following surgery.

The benefits of the direct anterior approach continued to be reflected in superior function (physical performance), measured in walking distance (unlimited and stairs), HHS,

Acknowledgment

We thank Toni Kingsley for her editorial contribution in manuscript development and Tom Gruen for radiographic evaluation.

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    The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2013.01.034.

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