Limited benefits of the direct anterior approach in primary hip arthroplasty: A prospective single centre cohort study

• Published in: Journal of orthopaedics 2017-03, Vol.14 (1), p.53-58
• Main Authors: Jelsma, Jetse, Pijnenburg, Rik, Boons, Harm W, Eggen, Peter J.M.G, Kleijn, Lucas L.A, Lacroix, Herman, Noten, Hub J
• Format: Article
• Language: English
• Subjects: Anterolateral approach; Direct anterior approach; Direct lateral approach; Original; Orthopedics; Posterolateral approach; Primary total hip replacement
• ISSN: 0972-978X; 0972-978X
• DOI: 10.1016/j.jor.2016.10.025

Abstract Background Since years a discussion is held on the best approach to perform total hip replacement (THR). Risk of dislocation, abductor weakness and a possible difference in rehabilitation are mentioned. We performed this study to objectify that the use of the direct anterior approach (DAA) results in a faster rehabilitation after THR compared to the non-DAA (posterolateral and anterolateral) approach. Methods A single centre prospective cohort study was conducted. Pre- and 16-weeks postoperative completed PROMs like the VAS, PSC, GPE and HOOS were analyzed. A leg press and power test were performed. Functional capacity was determined by the TUG and the 6MWT. Results A total of 119 patients were included for analysis: 87 in the DAA group, 32 in the non-DAA group. There were no differences in general baseline characteristics. The length of stay was significant ( p = .000) shorter in the DAA group. At 16 weeks, the DAA group showed a significant greater improvement with respect to the VAS and HOOS. Also significant differences for all strength, power and functional capacity parameters between the pre- and postoperative measurements were found. A subgroup analysis at 6-weeks postoperative showed significant improvements in the TUG ( p = .009) and 6MWT ( p = .009) in the DAA group, but not in the non-DAA group. Conclusion PROMs, strength, power and functional capacity tests show significant improvement in all approaches after THR. There seems to be a small advantage in favour of the DAA, in particular directly postoperative and the first postoperative weeks.