title: Does surgical approach in total hip arthroplasty affect rehabilitation, discharge disposition, and readmission rate?
abstract: There is a substantial preoccupation with different surgical approaches and minimally invasive techniques that may improve clinical outcomes for patients who undergo total hip arthroplasty. This study assessed the impact on hospital-related outcomes of the direct anterior approach (DAA) compared with the posterior approach (PA) performed by a single surgeon in 100 consecutive patients in each cohort. Patient age was similar in the DAA (61 ± 1.1 years) compared with the PA (62 ± 1.3, p = 0.733); however, BMI tended to be lower in DAA patients (29.1 ± 0.8) compared with PA patients (31.3 ± 0.7, p = 0.057). The DAA compared with the PA was associated with significantly less blood loss (285 ± 15 vs. 367 ± 21ml, p = 0.002) and transfusions (18 vs. 39 units, p = 0.009), less narcotic usage on postoperative days 1-3 (101 ± 12 vs. 146 ± 12 morphine equivalent dose, p = 0.010), a quicker hospital discharge (70 ± 3.3 vs. 97 ± 5.5 hours, p < 0.001), and a more favorable disposition (97% vs. 84% discharged home, p = 0.003). Thirty-day readmission rate was significantly higher with the PA (9%) compared with the DAA (1%, p = 0.030). The number of cups in the safe zone (5° to 25° anteversion and 30° to 50° inclination) was significantly higher with the DAA (92%) compared with the PA (75%, p = 0.002), possibly attributed to fluoroscopy used with the DAA. The DAA muscle-preservation technique may have led to the benefits observed in this study compared with the muscle-splitting technique associated with the PA.
authors.affiliation: Department of Orthopaedic Surgery Wake Forest School of Medicine Winston-Salem, North Carolina.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Schweppe
authors.affiliation: Department of Orthopaedic Surgery Wake Forest School of Medicine Winston-Salem, North Carolina.
authors.forename: Thorsten M
authors.initials: TM
authors.lastname: Seyler
authors.affiliation: Department of Orthopaedic Surgery Wake Forest School of Medicine Winston-Salem, North Carolina.
authors.forename: Johannes F
authors.initials: JF
authors.lastname: Plate
authors.affiliation: Department of Orthopaedic Surgery Wake Forest School of Medicine Winston-Salem, North Carolina.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Swenson
authors.affiliation: Department of Orthopaedic Surgery Wake Forest School of Medicine Winston-Salem, North Carolina.
authors.forename: Jason E
authors.initials: JE
authors.lastname: Lang
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods / Q000706:statistics & numerical data*; D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D015995:Prevalence; D020127:Recovery of Function; D012046:Rehabilitation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D016896:Treatment Outcome