A randomised trial comparing spatio-temporal gait parameters after total hip arthroplasty between the direct anterior and direct lateral surgical approaches

Abstract

Introduction:

Total hip arthroplasty (THA) is a successful procedure for relieving symptoms of severe osteoarthritis. Surgical approach is a key factor in early recovery and although controversial, little has been written about the direct anterior (DA) approach using objective early measures.

Methods:

78 participants were prospectively enrolled to undergo a THA through either a DA or direct lateral (DL) surgical approach. Outcome measures were collected preoperatively and at discharge from the hospital, and 2-, 6- and 12-weeks. Outcome measures included the GAITRite^® system to measure gait velocity, stride length, single-limb support and single-limb support symmetry. At each time point participants also completed the Timed Up and Go (TUG), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), 12-Item Short-Form Survey (SF-12), Harris Hip Score, and pain visual analog scale (VAS).

Results:

We found statistically significant differences in gait velocity at discharge, 2-weeks and 6-weeks in favour of the DA group (all p < 0.01). We also found significant differences in favour of the DA group for single-limb support symmetry at 6-weeks (p < 0.01) and 12-weeks (p < 0.01). The time to complete the TUG test was also significantly shorter in the DA group at 2-weeks (p < 0.01) and 6-weeks (p < 0.01) compared to the DL group. However, there were no statistically significant differences in any of the patient-reported outcomes.

Conclusion:

The DA surgical approach was found to offer significant early advantages in function compared to the DL group, with no differences in quality of life or pain.

Keywords

Direct anterior direct lateral gait Hardinge Heuter total hip arthroplasty

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