Favourable outcomes of fast-track hip arthroplasty using the direct superior approach,but no clinically superior postoperative PROMs compared to the posterolateral approach

Abstract

Background:

In comparison to the traditional posterolateral approach (PLA) for total hip arthroplasty (THA), the direct superior approach (DSA) is an alternative, less invasive posterior approach. Its minimally-invasiveness could make the DSA suitable for implementation in fast-track surgery. This study evaluated outcomes of a fast-track protocol including the DSA and compared patient-reported outcome measures (PROMs) to national data of the PLA.

Methods:

A single-surgeon series of 50 primary THA patients who underwent fast-track DSA surgery with short-acting articaine spinal anaesthesia were retrospectively reviewed. Length of hospital stay (LOS), postoperative in-hospital pain (0–10 NRS rest/activity), patient satisfaction (1–10 NRS), adverse events and PROMs until 1 year post-surgery were collected. Data of 858 matched THAs of the PLA from the Dutch Arthroplasty Register was used for a comparison of PROMs.

Results:

Median LOS was 2 (range 1–7) days. Overall mean in-hospital pain scores were 1.6 ± 0.9 (rest) and 2.2 ± 0.9 (activity). Patient satisfaction score (only available in n = 10, 20%) was 8.6 ± 1.3 on average. A dislocation occurred in 1 patient. Compared to baseline, all PROMs scores improved after 3 and 12 months of follow-up. PROMs scores of the fast-track DSA group were better than the national PLA averages at each time point, including the baseline assessment. However, between-group differences were small and not significant.

Conclusions:

Fast-track THA surgery using the DSA and short-acting articaine spinal anaesthesia demonstrated a short LOS, low in-hospital pain scores and few serious complications. Postoperative PROMs scores were good, but not clinically superior to nationwide PLA outcomes.