The Impact of Surgical Technique on Patient Reported Outcome Measures and Early Complications After Total Hip Arthroplasty

Interesting paper published in April 2017 edition of the Journal of Arthroplasty (link):


The study examined patient and surgeon reported outcome measures, complications during index admission, length of stay, and discharge disposition in a series of total hip replacements performed via the direct anterior  posterolateral approach.


Five surgeons performed 2698 total hip replacements (1457 Direct Anterior  vs 1241 Posterolateral) between January 2010 and June 2015. Complications during the index admission were recorded using claims and billing data. Harris Hip Scores (HHS) and Hip disability and Osteoarthritis Outcome Scores (HOOS) were collected in a subset of patients.


Patients in the DA group had shorter  length of stay (2.3 DA vs 2.7 PL days) and a larger proportion of patient discharges to home (79.0% DA vs 68.7% PL). Surgical and medical  complications during index admission were equivalent between groups. HHS (n = 462) favouored the direct anterior group at an early follow-up, but did not differ at 1 year. Logistic regression revealed that patients in the Direct Anterior group were more likely to report no pain, no limp, walk unlimited distances, and climb stairs without the use of the railing at 3-to 6-month follow-up. HOOSs were equivalent at all follow-ups regardless of approach.


Patients in the Direct Anterior group had shorter length of stay and were more likely to be discharged home. The Direct Anterior group had better HHS at 3- to 6-month follow-up than patients in the posterolateral group, with no difference in medical or surgical complications during index admission.