Comparison of Early Functional Recovery After Total Hip Arthroplasty Using a Direct Anterior or Posterolateral Approach

A hot-off the press paper (Journal of Arthroplasty Nov 2017) investigated early functional recovery after Direct Anterior vs Posterior Approach Total Hip Replacement in a randomized control study.

The authors reported lower pain scores, lower serum (blood test) markers for muscle damage, better implant positioning and better early functional recovery at 3 months post surgery with the Direct Anterior Approach group. They did report that these functional outcome scores equalised with (DAA vs posterior) by 6 months post surgery.

Proponents of the posterior approach will conclude that the approach used for a hip replacement doesn’t matter as functional scores will eventually equalise – and on that point they’re totally correct. A good long term result can be achieved via any approach and there are many valid and successful ways to do a hip replacement.

However, my practice is interesting in that elderly patients are the exception rather than the rule.

I see plenty of working-age adults with severe arthritis who want/need to get back to work quickly. Of those not working, many are healthy retirees who want to golf or do that long awaited world cruise or other active pursuits. For these patients a shorter vs a prolonged recovery is not an academic exercise but rather a very real and relevant consideration.

Even for the genuinely elderly/frail patient, recovery time is not trivial.The approach used for a hip replacement does not affect the long term success of the surgery and there are many valid ways to do hip replacement surgery. However, my personal experience mimics the results of this study in that DAA (in my experience) facilitates fast early recovery.