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Updated: May 25, 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
Return to Sport and Exercise After Direct Anterior Approach Total Hip Arthroplasty: Minimum Five-Year Outcomes
Jacob D Mikula1, Sandeep Yanamala1, John Kelly1
1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota.
Background:
Younger, more active patients increasingly undergo total hip arthroplasty (THA) and commonly inquire about expectations and timelines regarding return to sport (RTS) and exercise. The direct anterior approach (DAA) may facilitate faster recovery and decreased instability risk, but long-term RTS data are limited.
Methods:
A retrospective registry review identified all primary DAA THAs from 2010 to 2020. Patients who had less than five-year follow-up were excluded. Eligible patients completed a survey on preoperative and postoperative sport participation, time to RTS, and potential factors limiting RTS. A total of 886 patients (466 women and 428 men) responded to the survey. Their mean age was 62 years (range, 28 to 93), and their mean body mass index was 29.0 (range, 17 to 49).
Results:
In the year prior to THA, 84% walked, 31% hiked, 27% cycled, and 11% ran. Postoperatively, 74% returned fully to prior activities, and 16% returned with modifications, with 90% of these patients achieving RTS within one year. High-impact sport participation decreased from 24% preoperatively to 10% postoperatively, and running decreased from 11 to 5% (P < 0.001). Those who discontinued running most commonly cited surgeon advice (34%), fear of damaging the joint (21%), and pain (20%) as contributing factors for running cessation. Overall rates of revision were 4.5% for the running cohort and 3.2% for the nonrunning cohort (P = 0.651).
Conclusions:
At a minimum five-year follow-up, most patients who underwent DAA THA successfully returned to sporting activities, typically within six months postoperatively. The majority resumed low-impact sports, while participation in high-impact activities declined. Patient counseling and fear of joint damage were common reasons for avoiding RTS, despite mixed evidence suggesting increased risks of arthroplasty failure with high-level activities. Future prospective studies are warranted to better guide postoperative activity recommendations and clarify the long-term implications of sport participation after THA.
