Effect of Greater Trochanteric Fractures on Patient Reported Outcomes After Direct Anterior Total Hip Arthroplasty

Total hip arthroplasty (THA) via the direct anterior approach (DAA) is favored for avoiding gluteal muscle disruption and promoting faster recovery. A known complication of DAA is greater trochanteric fracture (GTFX). This study compared patient-reported outcomes (PROs) between patients who sustained GTFX and those who did not following THA using DAA.

A retrospective review was conducted of patients who underwent THA via DAA. Primary outcomes included Mental and Physical Patient-Reported Outcomes Measurement Information System scores, Hip Osteoarthritis Outcome Score for Joint Replacement (HOOS JR), and Forgotten Joint Score. Secondary outcomes included ambulation status, disposition, length of stay, complications, emergency department visits, and return to the operating room within 1 year. Patients without at least baseline and 6-month or 1-year PROs were excluded.

Ninety-two THAs were analyzed; 13 patients (14%) sustained a GTFX. Baseline characteristics and preoperative PROs were similar between groups. At 6 months, the GTFX group had significantly lower HOOS JR scores (68.5 ± 18.1) compared to the non-GTFX group (79.8 ± 18.0; P = .0472). No significant differences in PROs were observed at 1-year. Two patients (15%) with GTFX and 2 (3%) without GTFX returned to the operating room (P = .0943). No other significant differences in secondary outcomes were noted.

GTFX following THA via DAA are associated with worse HOOS JR scores at 6 months, suggesting a temporary delay in recovery. However, these differences resolve by 1 year, indicating GTFX may not impact long-term functional outcomes.