Patient's perspective on direct anterior versus posterior approach total hip arthroplasty

Total hip arthroplasty approach comparison focused on patient's perspective. The direct anterior approach (DAA) has gained immense popularity in the last decade and is widely advocated as a superior approach in terms of quicker recovery and better overall outcome. However, the question if the level of DAA promotion is justified seems to be rarely posed.

A single-surgeon consecutive series of patients who underwent bilateral THA, one in DAA and the other in posterior approach (PA). The same implant design and same component sizes were used for the both sides. All the operations were performed by a single surgeon under the same pre- and post-operative care protocol.

Twenty-one patients underwent bilateral THA, mean age 60.09 years. Oxford Hip Score (OHS) was used for functional outcome assessment. There were no statistically significant differences between two approaches in terms of functional outcome (mean OHS for DAA series was 42.95 and that for the PA was 43.38, p 0.07 at an alpha level of 0.05). Fifteen patients gave the advantage to PA, and six patients favoured DAA.

By study design, we tried to reduce the biases and acquire approach appraisal from patient's perspective. We anticipated the outcome in favour of DAA, but the results favoring PA came as a surprise. Future prospective randomized studies on evaluation of DAA and other approaches not only from surgeon's or industry's point of view, performed on a larger and more uniform groups, are warranted to further explore the subjective differences between DAA and PA.