Comparison of pain,early functional recovery,and inpatient opioid consumption between direct anterior and posterior approach total hip arthroplasty

Abstract

Introduction:

Use of the direct anterior approach (DAA) in total hip arthroplasty (THA) has increased, with suggested benefits of faster recovery and less pain. However, consensus regarding the optimal approach is lacking. This study compared post-operative pain, functional recovery, and opioid use between DAA and posterior approach (PA) THA.

Methods:

We retrospectively reviewed 3618 primary THAs (DAA, n = 1809; PA, n = 1809) performed by fellowship-trained surgeons between 2019–2024. Cohorts were matched by age, sex, BMI, and CCI. Postoperative visual analogue scale (VAS) pain scores, Activity Measure for Post-Acute Care (AM-PAC) scores, and opioid consumption (morphine milligram equivalents, MME) were compared using independent t-tests.

Results:

Mean VAS pain scores were similar within the first 24 hours postoperatively. From 18 to 24 hours postoperatively, the PA cohort showed significantly higher VAS scores (4.32 [DAA] vs. 4.68 [PA], p = 0.006), although these differences are not clinically significant. Mean AM-PAC scores were significantly higher in the DAA cohort within 6 hours (22.3 [DAA] vs. 21.4 [PA], p < 0.001) and from 18 to 24 hours post-surgery (21.8 [DAA] vs. 20.1 [PA], p < 0.001), but these small differences do not reflect clinical significance. MME comparison showed a trend towards decreased opioid consumption within the DAA cohort, but the clinical relevance of these differences is unknown.

Conclusions:

Pain, function, and opioid use were largely comparable between DAA and PA, with minor statistical differences unlikely to be clinically meaningful.