Direct Anterior Approach in Total Hip Arthroplasty Leads to Superior Outcomes at 3-Month Follow-up When Compared With the Posterior Approach: A Matched Study Using Propensity Score Analysis


The purpose of this study was to report and compare early outcomes during the first 3 months of the recovery phase in patients who underwent primary total hip arthroplasty (THA) with direct anterior approach (DAA) and posterior approach (PA).

Background: The DAA for primary THA has gained popularity within the past few years. Although controversy exists regarding the long-term benefit when compared with the PA, several authors have reported markedly better outcomes in the early recovery weeks, when using DAA.

Methods: For this study, data were prospectively collected and retrospectively reviewed for all primary THAs from March 2014 to October 2017. Included patients underwent primary THA through DAA or PA and had minimum 3-month postoperative measures for the Harris Hip Score, Forgotten Joint Score-12, Veterans RAND 12 Mental (VR-12 Mental), Veterans RAND 12 Physical (VR-12 Physical), 12-Item Short-Form (SF) Survey Mental, 12-Item SF Survey Physical (SF-12 Physical), Visual Analog Scale, and patient satisfaction. An analysis using propensity score matching was done to establish the DAA and PA groups. Matching (1:1 ratio) was conducted based on the following covariates: age, sex, body mass index, and laterality.

Results: Twenty-four DAA THA patients were successfully matched using propensity scoring to 24 PA THA patients. The DAA group demonstrated significantly higher scores for the following patient-reported outcome scores: Harris Hip Score, VR-12 Mental, VR-12 Physical, and SF-12 Physical (P = 0.0090, P = 0.0388, P = 0.0063, and P = 0.0132, respectively).

Conclusion: At 3-month follow-up, both the DAA and PA groups reported favorable outcomes after THA. However, the DAA group scored markedly higher regarding quality-of-life outcomes when compared with a propensity score-matched group of PA patients.

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