Comparing early practice outcomes of the direct anterior approach in total hip arthroplasty vs alternative approaches in direct anterior fellowship trained surgeons

Abstract

Aims

Total hip arthroplasty (THA) approach typically depends on surgeon preference and training. The direct anterior approach (DAA) has increased appeal due to its muscle sparing planes. We evaluated complications of DAA and non-DAA THA by DAA fellowship trained surgeons. We hypothesized complications of DAA THAs would have a noninferior complication profile compared to alternative approaches.

Methods

Retrospective review of first 50 DAA and first 50 alternative-approach THAs performed by three fellowship-trained adult reconstruction surgeon's first year practice. Patient demographics, comorbidities, complications, radiographic acetabular inclination, acetabular anteversion, and femoral stem alignment were analyzed. Power analysis, univariate, multivariate regression models completed for analysis.

Results

150 cases (DAA) and 150 controls (alternative-approach) with median follow-up of 27.7 weeks (194 days). There was a significant difference in sex (56.7 % vs 35.3 % males) and median BMI (29.2 kg/m2 vs 36.5 kg/m2) between groups and no significant difference in total perioperative complications between cases (n = 51 events) and controls (n = 53 events). There were significantly reduced odds of 30 day re-admissions and 90-day ED visits in the DAA patients in univariate analysis (OR = 0.301, p = 0.008 and OR = 0.553, p = 0.045) but no significance in multivariate regression analysis (OR = 0.071, p = 0.104 and OR = 0.445, p = 0.251). Radiographic acetabular cup inclination (p = 0.31), acetabular cup anteversion (p = 1.00) and femoral stem alignment (p = 0.21) had no significant difference between groups.

Conclusion

Formal fellowship training in the DAA, including appropriate technique and patient selection, demonstrates no difference in perioperative complications, 30-day re-admissions, 90-day ED visits compared to alternative approaches, offering DAA fellowship trained surgeons immediate successful outcomes.