Approach-Based Complication Rates of Total Hip Arthroplasty in the Medicare Population

The direct anterior approach (DAA) has become increasingly more popular for total hip arthroplasty (THA). Critics of the DAA maintain that a higher complication rate exists; however, data collection is prone to bias as the outcome is collected by the surgeons performing either an anterior or posterior approach (PA). This study aims to compare the short-term outcomes, including complication rates, in a Medicare population between THAs performed via DAA and PA.

Baseline patient data was obtained from our institution's database for bundled payments, an unbiased collection source. A retrospective chart review was conducted on 492 Medicare patients who underwent primary THA between October 2016 and September 2017 to separate patients into DAA and PA cohorts. Descriptive patient characteristics along with surgical and clinical data were collected. Statistical tests for significance were based on either t-tests or chi-squared. To control for demographic variables, a multivariable regression analysis was conducted.

Two hundred forty-one patients were included in the DAA cohort while 251 were included in the PA cohort. Surgical time (74.39 vs. 103.03 minutes; p < 0.001) and length-of-stay (1.29 vs. 2.74 days; p < 0.001) in patients who underwent the DAA was revealed to be statistically lower compared to the PA cohort. Patients in the DAA cohort were statistically more likely to be discharged to home health agencies (HHA) or self-care compared to those in the PA cohort (93.4% vs.74.5%; p < 0.001). There were no statistical differences in 90-day readmission rates or morphine milligram equivalents per day between both cohorts.

The DAA to THA resulted in shorter surgical time, length-of-stay, and increased likelihood of discharge to HHA or self-care when compared with the PA. There were no differences in opioid consumption and complications leading to 90-day readmission.