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