Clinical, Radiological, and Functional Outcomes of Tableless Direct Anterior Total Hip Arthroplasty: A Single-Center...

Introduction The direct anterior approach (DAA) is underutilized in Malaysia due to limited surgeon exposure and the perceived need for specialized traction tables despite its documented advantages. This study evaluates short-term clinical, radiological, and functional outcomes of tableless DAA total hip arthroplasty (THA) performed using a standard operating table in a Malaysian tertiary center. Methodology This retrospective cohort case series included all nine patients (10 hips) who underwent primary DAA THA from October 2023 to October 2024. Outcomes assessed were pain scores, mobilization time, complications, acetabular orientation, femoral offset, limb-length discrepancy (LLD), subsidence, and functional status via Harris Hip Score (HHS) during follow-up at one, three, and six months. Descriptive statistics and non-parametric tests (Friedman, Cochran Q) were applied. Results Median age was 58 years, and median body mass index (BMI) was 24.8 kg/m². Pain improved rapidly (visual analog scale (VAS) score: 1.4 on day 1 to 0.8 on day 3). Most patients mobilized with support by day 2, and seven patients were discharged by day 3. Complications included two intraoperative greater trochanteric fractures (both tension-band wired) and one superficial infection. No dislocations, lateral femoral cutaneous nerve (LFCN) palsy, deep vein thrombosis/venous thromboembolism (DVT/VTE), subsidence, or implant loosening were observed. Radiographs demonstrated median cup inclination of 44.1° (44.0°-45.2°), median femoral offset difference of 2.0 mm, and mean LLD of 3.0 mm. Median HHS improved from 42 preoperatively to 92 at six months (P < 0.001). Conclusions Tableless DAA THA performed on a standard operating table is safe, reproducible, and yields favorable early outcomes comparable to international DAA benchmarks. These findings support its wider adoption in resource-limited Malaysian arthroplasty centers.