Related Experiment Video
Updated: May 20, 2026
The Transition to an Anterior-Based Muscle Sparing Approach Improves Early Postoperative Function but is Associated with a Learning Curve
Published on: September 7, 2022
Surgical approach and functional recovery after total hip arthroplasty within the International Classification of
Philippe Henry1, Mathias Blandeau2, Philippe Pudlo2
1Univ. Polytechnique Hauts-de-France, LAMIH, CNRS, UMR 8201, F-59313 Valenciennes, France; Iso-Santé Réadaptation, Sherbrooke, J1H 4B5, Québec, Canada.
Background:
Total hip arthroplasty (THA) is the standard treatment for end-stage hip osteoarthritis, providing pain relief and functional improvement, yet gait deficits often persist despite good radiological and clinical outcomes. Minimally invasive approaches, such as the direct anterior (DAA) and anterolateral (ALA) techniques, are hypothesized to enhance early recovery compared with the conventional posterior approach (PA). We aimed to determine the impact of surgical approach on early gait restoration and patient-centered outcomes after THA.
Methods:
A prospective cohort of 189 participants undergoing primary unilateral THA for severe osteoarthritis was evaluated: DAA (n = 63), PA (n = 61), ALA (n = 65). Assessments were performed pre-operatively and 3 months post-operatively using the WHO-ICF framework: radiographic parameters and Oxford Hip Score (OHS) for body structure/function; 3-dimensional instrumented gait analysis for activity (spatiotemporal, kinematics, kinetics, mechanical work, and energy cost); and the Short Form 36 Health Survey (SF-36) physical and mental scores for participation. Paired-ANOVA tested treatment effects and between-approach differences (P <0.05). Principal-component analysis explored relationships between biomechanical and clinical outcomes.
Results:
THA significantly improved OHS, SF-36 scores, step length, sagittal hip/pelvic kinematics, hip-flexion moment, pendular recovery, and reduced external mechanical work and metabolic cost of walking (all P <0.05). Clinical and participation gains were similar across approaches, but gait analysis revealed approach-specific advantages: ALA showed greater step-length gain and lower energy cost, whereas DAA exhibited larger reductions in external work and better pendular recovery.
Conclusions:
THA markedly enhances function and quality of life regardless of approach, yet minimally invasive DAA and ALA confer earlier biomechanical benefits in gait efficiency compared with PA. Combining gait analysis with clinical scores highlights these mechanistic differences and supports targeted rehabilitation strategies to optimize locomotor recovery after THA.
