Comparative analysis of direct anterior approach versus posterior approach in primary total hip arthroplasty: evaluating minimum 5-year outcomes and clinical important thresholds

Abstract

Background:

In total hip arthroplasty (THA), the direct anterior approach (DAA) has gained popularity due to reported superior early outcomes compared to the posterior approach (PA). The aim of this study was to compare the outcomes of the DAA and PA in patients undergoing primary THA at midterm follow-up, with a secondary comprehensive analysis of the clinically important thresholds.

Methods:

Data were retrospectively reviewed for patients who underwent a primary THA from 2009 to 2018. Patients were included if they had completed postoperative patient-reported outcome (PRO) scores at a minimum of 5-year follow-up or had a documented endpoint. Patients were divided into 2 groups based on the approach and propensity-matched 1:1 based on age, use of robotic assistance, sex, and body mass index. The analysis also included comparisons of clinically significant thresholds, complications, and revision rates.

Results:

176 hips were matched in each group. Both the DAA and PA groups demonstrated significant and comparable improvement across all PROs from the preoperative baseline to the midterm follow-up time point. Both groups also demonstrated comparable midterm outcomes across all PROs. Comparable (p > 0.05) rates of achieving PASS and MCID were observed. The overall complication rate was significantly higher in the PA group (p < 0.05).

Conclusions:

Both groups reported positive outcomes at a minimum 5-year follow-up. Both groups achieved comparable midterm outcomes across all PROs and reached clinically significant thresholds at comparable rates. Moreover, the DAA group faced a lower risk for complications, which should be taken into consideration when deciding on a surgical approach.