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The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve

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Does Surgical Approach Affect Patient-reported Function After Primary THA?

Sara C Graves¹, Benjamin M Dropkin², Benjamin J Keeney³

¹Department of Orthopaedics and Sports Medicine, Central Vermont Medical Center, Berlin, VT, USA.

Clinical Orthopaedics and Related Research

|December 2, 2015

Summary

This summary is machine-generated.

The direct-anterior approach for total hip arthroplasty (THA) shows a small, transient physical function benefit at three months but involves increased blood loss and transfusion rates compared to the posterior approach. Further research is needed for definitive conclusions.

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Area of Science:

Orthopedic Surgery
Biomedical Engineering
Rehabilitation Medicine

Background:

Total hip arthroplasty (THA) is effective for hip osteoarthritis pain and function but has a long recovery period.
The direct-anterior approach is hypothesized to offer faster recovery than transgluteal approaches due to potentially less muscle trauma.

Purpose of the Study:

To compare patient-reported physical function at 1 and 3 months post-THA between direct-anterior and posterior approaches.
To evaluate operative times and non-institutional discharge rates for direct-anterior versus posterior THA.

Main Methods:

A comparative study of 135 posterior approach THAs and 86 direct-anterior approach THAs performed by the same surgeon.
Outcome measures included Veterans RAND-12 scores (PCS/MCS), UCLA activity scores, operative blood loss, transfusion rates, and adverse events.
Data analyzed using logistic and linear regression, controlling for confounding variables.

Main Results:

Direct-anterior approach showed worse Mental Component Summary (MCS) scores at 1 and 3 months but improved Physical Component Summary (PCS) scores at 3 months.
No significant differences in PCS at 1 or 12 months, or in UCLA scores.
Direct-anterior approach was associated with increased operative blood loss and higher in-hospital transfusion rates, but similar operative times and no difference in adverse events.

Conclusions:

The direct-anterior approach may offer transient, modest physical function benefits at 3 months post-THA.
Increased blood loss and transfusion rates are potential disadvantages of the direct-anterior approach, even with surgeon experience.
Preliminary findings suggest similar long-term outcomes, but prospective randomized studies are needed for definitive comparisons.