Two THA Approaches Yield Similar Outcomes

A recent retrospective study published in BMC Musculoskeletal Disorders compared complication rates and bleeding associated with the direct anterior approach (DAA) and anterolateral approach in total hip arthroplasty (THA).

The study began with 1,408 elective THA patients from a single institution. From this cohort, researchers created two matching groups with 396 patients each. Matched patients had similar age, gender, body mass index (BMI), American Society of Anesthesiologists’ (ASA) score, and surgeon’s experience.

The overall average age for the matched groups was 68.7 ± 10.3 years; 61.3% (n = 243) were female. Mean BMI was 28.1 ± 4.9 kg/m². Most patients (n = 284, 71.7%) had an ASA score of 2, while 22.22% (n = 88) and 6.1% (n = 24) had a score of 3 and 1, respectively.

Zooming in on the Benefits of the Direct Anterior Approach to a Hip Replacement Procedure
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Perioperative non-compensated blood loss rates were similar among the DAA and anterolateral approach cohorts (387 ± 163 mL vs. 405 ± 170 mL, P = 0.126); total blood loss rates were also comparable (450 ± 362 mL vs. 469 ± 292, P = 0.400). Overall fracture rates did not significantly differ between DAA patients (n = 6, 1.5%) and anterolateral approach patients (n = 4, 1%), nor did surgical site infection rates (n = 1, 0.3% vs. n = 4, 1%, respectively; P = 0.162).

“The transfusion rate was significantly higher with the anterolateral approach (14.1% vs. 5.8%, p < 0.001) at an overall transfusion rate of 9.9%. Although the transfusion rate was higher, the total blood loss was without significant difference (p = 0.400),” the researchers observed. The anterolateral group also had a much higher complication rate (n = 70, 17.6%) than the DAA group (n = 48, 12.1%; P = 0.018). DAA patients had significantly more dislocations (n = 9, 2.2%) than the anterolateral approach cohort (n = 2, 0.5%; P = 0.032).

Justin Wilcox, PA-C, discusses #FAI and #OA of the hip with two talks to close out our day with the latest on arthroscopy and arthroplasty – including the direct anterior approach for #THA. #OrthoInTheWest pic.twitter.com/Rqh0Jaesbf

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Two patients in each group sustained intraoperative fractures. In the DAA cohort, one was a femoral fissure Vancouver B and the other was a Vancouver type A fracture; in the anterolateral approach group, one was a minimally dislocated acetabular fracture and the other was a Vancouver B type fracture.

“The only difference in surgical complications was the higher dislocation rate for DAA, which was higher than in comparable studies,” the study authors wrote. “Even though preoperative planning was undertaken on digital radiography, the better exposure in the anterolateral approach still makes a difference, which could influence the cup position. Also, the smaller 28 mm head was used throughout, whereas it has been shown that the use of a larger head decreases the dislocation rate.”

The researchers concluded, “Direct anterior approach has comparable short-term surgical complications and reduces the transfusion and general complication rate when compared with the Watson Jones anterolateral approach.”

Gait analysis after total hip arthroplasty using direct anterior approach versus anterolateral approach: a systematic review and meta-analysishttps://t.co/wnor0fz3R0 pic.twitter.com/To9etBYDk4

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