Direct anterior versus posterior approach for total hip arthroplasty: a multicentre, prospective, randomized clinical trial

Abstract

Background: The ideal approach for a total hip arthroplasty (THA) would be kind to soft tissues, have the lowest complication rates and be easily reproducible. Although there have been several attempts to find the best approach for THA in the last decade, a definitive answer has not been found. We performed a prospective study to compare the direct anterior and posterior approaches for THA in terms of hospital length of stay, functional outcome, pain, implant position, complications and surgical time.

Methods: A prospective, randomized, multicentre clinical study was conducted between February 2011 and July 2013, with an average follow-up of 55 months. Patients undergoing the direct anterior or posterior approach for THA were enrolled. Hospital length of stay, surgical time and complications were documented. The Harris Hip Score and visual analogue scale were used to monitor functional outcome and pain until 5 years postoperatively. Radiologic analysis was used to assess implant position.

Results: Fifty-five patients (28 undergoing the direct anterior approach, 27 undergoing the posterior approach) were enrolled in this study. Length of stay, functional outcome, pain, implant position and complications were similar for the 2 approaches. There was a trend toward a better functional outcome for patients who underwent the direct anterior approach in the first 3 months postoperatively, with a peak at 4 weeks (Harris Hip Score 76.7 v. 68.7; p = 0.08). Average surgical time for the direct anterior approach was significantly longer (69.9 v. 45.7 min; p = 0.002).

Conclusion: The direct anterior approach for THA appears to be a safe and effective option. However, there is no significant difference in hospital length of stay or postoperative recovery between the 2 approaches.

Clinical trial registration: Clinicaltrials.gov, no. NCT03673514.

Conflict of interest statement

Competing interests: G. Laflamme and S. Leduc have received consulting fees from Stryker, outside the submitted work. B. Benoit has received consulting fees from Medacta, Stryker and Bioventus, outside the submitted work. The Hôpital Sacré-Coeur de Montréal has received funding for research and educational purposes from Arthrex, ConMed, Depuy, Linvatec, Medacta, Smith & Nephew, Stryker, Synthes, Tornier, Wright and Zimmer Biomet. No other competing interests were declared.

Figures

Fig. 1

Comparison of Harris Hip Score (HHS) values preoperatively and at different time points postoperatively for patients who underwent the direct anterior approach (DAA) and posterior approach (PA) for total hip arthroplasty. The maximum score possible is 100. Preop = preoperative.