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Superior Transverse Atraumatic Reconstruction Total Hip Arthroplasty Achieves Similar Satisfaction and Minimal
Hong Yu Jared Chua1, Chen Jiawei1, Seng-Jin Yeo1
1Department of Orthopaedics, Singapore General Hospital, Singapore Health Services, Singapore, Singapore.
Background:
Numerous studies comparing the direct anterior approach (DAA) and postero-lateral approach in total hip arthroplasty (THA) have been inconclusive, mostly demonstrating earlier recovery with DAA, with no differences in outcomes by one year. However, there are limited studies comparing the DAA with the superior transverse atraumatic reconstruction (STAR) THA, which is a type of postero-lateral approach. This study aimed to compare the 2-year follow-up patient-reported outcome measures, satisfaction, and complication rates between DAA and STAR THA.
Methods:
A retrospective analysis of all primary THAs performed (January 2018 to December 2022) at a high-volume tertiary hospital was conducted. The study included patients >60 year at the time of THA with minimum 2-year outcomes of Oxford Hip Score, Western Ontario and McMaster University Arthritic Index, Short-Form 36 Health Survey subscale and summative (physical component score/mental component scores), patient satisfaction, and expectation fulfillment scores. The DAA THA was performed with either fluoroscopic or robotic assistance, whereas the STAR THA was performed manually. Logistic regressions were performed to estimate propensity scores, followed by greedy matching in a 1:1 ratio to establish the DAA and STAR groups. Parametric and nonparametric statistical tests were used to compare postoperative scores and the proportion attaining a minimal clinically important difference (MCID). A total of 132 DAA THA were successfully matched with 132 STAR THA.
Results:
The DAA group demonstrated significantly higher scores in 2-year postoperative Oxford Hip Score (P = 0.0140), Western Ontario and McMaster University Arthritic Index stiffness (P = 0.0455), physical function (P = 0.0125), Short-Form 36 Health Survey physical function (P = 0.00537), general health (P = 0.0495), social function (P = 0.0266), physical component score (P = 0.0478), and mental component score (P = 0.0482). There was no difference in MCID attainment, patient satisfaction, or expectation fulfillment scores noted.
Conclusions:
While technology-assisted DAA THA demonstrated better functional outcomes at two years, its clinical relevance may be limited, as manually performed STAR THA also attained MCID thresholds and yielded high patient satisfaction rates without additional complications. This suggests that slightly lower functional scores do not compromise overall THA success.
