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Prospective Assessment of Expectations of Recovery Following Total Hip Arthroplasty: Patients Expect Less Pain With
Francesca R Coxe1, Ahmed Deeb1, Pravjit Bhatti1
1Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York.
Background:
Use of the direct anterior approach (DAA) total hip arthroplasty (THA) continues to grow, and patient preferences have evolved. This study aimed to determine whether preoperative expectations of postoperative recovery differ between patients who prefer the DAA THA versus those who do not.
Methods:
From 2024 to 2025, 225 patients (63% women, mean age 68 years) presenting for primary THA consultation were prospectively enrolled. There were four surgeons who participated, performing both DAA and posterior approaches. Patients self-identified as DAA-preferring or no preference (no preference or preferring an alternative approach). Expectations were assessed using the Hospital for Special Surgery Hip Replacement Expectations Survey and an open-ended question on approach preferences and sources of expectations. Fisher's exact tests, Welch's t-tests, and Wilcoxon rank-sum tests were used for categorical, continuous, and non-normal data, respectively.
Results:
There were 97 patients (43%) who preferred the DAA, 125 (55%) had no preference, and two (0.9%) preferred a posterior approach. The DAA-preferring patients were older (69 versus 67 years, P = 0.04), more often women (71 versus 57%, P = 0.04), and had lower body mass index (25 versus 28, P < 0.001). Overall expectation scores were similar between groups (80.2 versus 80.0, P = 0.9); DAA-preferring patients were more likely to expect not to require postoperative pain medication (77 versus 65%, P = 0.06). The DAA-preferring patients more commonly cited easier/faster recovery, less invasive surgery, and better outcomes and more often referenced the internet (P < 0.001), whereas no preference patients deferred to their surgeon.
Conclusions:
Many patients seeking elective THA expressed no approach preference. Those with a preference more commonly preferred the DAA. The DAA-preferring group had a lower body mass index and expected both less pain and need less pain medication postoperatively. These findings can help surgeons counsel patients preoperatively depending on their preexisting approach preference.
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