Direct Anterior Approach Versus Posterior Approach in Primary Total Hip Replacement: Comparison of Minimum 2-Year Outcomes
Authors: Maldonado DR, Kyin C, Walker-Santiago R, Rosinsky PJ, Shapira J, Lall AC, Domb BG
Background
- The direct anterior approach (DAA) and posterior approach (PA) are commonly used in primary total hip arthroplasty (THA). While the DAA is associated with better early recovery, long-term comparative data remain limited.
Methods
- This retrospective study matched 205 patients undergoing DAA with 205 patients undergoing PA. All had at least 2 years of follow-up, and outcomes were assessed using PROs, including VR-12, HHS, FJS-12, and satisfaction metrics.
Key Findings
- DAA patients reported significantly higher VR-12 mental and physical health scores at 2 years.
- No significant differences were found in HHS or FJS-12 between groups.
- Both groups demonstrated high levels of patient satisfaction and functional improvement.
Conclusions
- Both DAA and PA offer excellent long-term outcomes in THA. However, DAA may yield better patient-reported quality-of-life outcomes, particularly in mental and physical health domains.
What Does This Mean for Providers?
- When selecting a surgical approach for primary THA, the DAA may confer added value in terms of perceived quality of life, especially in active or younger populations.
- Despite similar functional outcomes (HHS, FJS-12), the improved mental and physical VR-12 scores in DAA patients may guide decision-making for patients prioritizing wellness and recovery perception.
- Surgeons should consider approach-related nuances—including learning curve, patient anatomy, and OR setup—when tailoring procedures.