Patient-Reported Outcomes and Preferences for Total Hip Arthroplasty Approach-Crossover Cohort Study

Background: Evidence comparing the Direct Anterior Approach (DAA) for total hip arthroplasty (THA) to other approaches is conflicting, particularly regarding patient-reported outcomes. This study aimed to compare the outcomes and preferences of the DAA and Posterolateral (PLA) and Lateral (LA) Approaches within a crossover cohort. Methods: This retrospective crossover study included 69 patients who underwent staged bilateral THA with a DAA on one hip and either a PLA (n = 29) or LA (n = 40) on the contralateral hip. At a minimum 12-month follow-up, patient-reported outcomes, including length of stay, mobilization, crutch use, functional scores (mHHS, HOOS-PS, and NRPS), and preferences, were collected via telephone survey and analyzed using a paired t-test. Results: Compared to other approaches, the DAA resulted in a significantly shorter length of stay (p < 0.001), earlier mobilization (p < 0.001), and shorter duration of crutch use (p < 0.001). At 12 months, the DAA group also reported higher modified Harris Hip Scores (p < 0.05) and lower pain scores (p < 0.05). The majority of patients preferred DAA to both PLA (60.7%) and LA (72.5%). Conclusions: In this within-patient comparison, DAA provided a significantly faster early recovery and was strongly preferred by patients. These early postoperative advantages are critical for patients, and should be prominent in the shared decision-making process for THA.