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Published on: September 7, 2022
Comparing Direct Anterior Approach Versus Posterolateral Approach in Total Hip Arthroplasty on Physical Function
Jesse C Christensen1, Dana L Judd2, Jeri E Forster3
1Veterans Affairs Salt Lake City Health Care System, Department of Physical Medicine and Rehabilitation, Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, USA.
Abstract:
Total hip arthroplasty (THA) is estimated to exceed 500,000 procedures annually in the United States. Often after THA, deficits observed range from poor physical performance, muscle weakness and joint mechanics compensation, negatively impacting return to daily physical function. The direct anterior approach (DAA) is theorized to cause less gluteal muscle disruption, potentially leading to better physical function recovery compared to the posterolateral approach (PLA) post-THA. This study evaluated differences in physical function recovery in 93 participants who underwent a primary, unilateral THA with either a DAA (n = 68) or PLA (n = 25) approach. Outcomes were assessed preoperatively, 10- and 24-weeks post-THA. Physical function recovery was measured as 6-min walk test, Functional Gait Assessment, daily step count, muscle strength (hip abductor, knee extensor, knee flexor) and joint mechanics during walking and step negotiation. Repeated measures analysis of covariance models were used to estimate the effect of surgical approach on outcomes over time, adjusting for age, sex, preoperative body mass index and surgeon years of experience. Participants with DAA demonstrated greater 6-min walk distance 24-weeks post-THA and greater hip abductor strength 10-week post-THA compared to PLA. Participants with DAA also demonstrated subtle reductions in hip and trunk mechanics during walking and step negotiation compared to PLA post-THA. Statement of Clinical Significance: The DAA resulted in better recovery in 6-min walk distance (24-weeks), hip abductor strength (10-weeks) and joint mechanics (10- and 24-weeks) when compared with the PLA post-THA. This suggests the DAA demonstrated marginal improvement in physical recovery, despite both surgical approaches showing success.
