title: Does the direct anterior approach in THA offer faster rehabilitation and comparable safety to the posterior approach?
abstract: BACKGROUND
  Newer surgical approaches to THA, such as the direct anterior approach, may influence a patient's time to recovery, but it is important to make sure that these approaches do not compromise reconstructive safety or accuracy.
  
  
  OBJECTIVE
  We compared the direct anterior approach and conventional posterior approach in terms of (1) recovery of hip function after primary THA, (2) general health outcomes, (3) operative time and surgical complications, and (4) accuracy of component placement.
  
  
  METHODS
  In this prospective, comparative, nonrandomized study of 120 patients (60 direct anterior THA, 60 posterior THAs), we assessed functional recovery using the VAS pain score, timed up and go (TUG) test, motor component of the Functional Independence Measure™ (M-FIM™), UCLA activity score, Harris hip score, and patient-maintained subjective milestone diary and general health outcome using SF-12 scores. Operative time, complications, and component placement were also compared.
  
  
  RESULTS
  Functional recovery was faster in patients with the direct anterior approach on the basis of TUG and M-FIM™ up to 2 weeks; no differences were found in terms of the other metrics we used, and no differences were observed between groups beyond 6 weeks. General health outcomes, operative time, and complications were similar between groups. No clinically important differences were observed in terms of implant alignment.
  
  
  CONCLUSIONS
  We observed very modest functional advantages early in recovery after direct anterior THA compared to posterior-approach THA. Randomized trials are needed to validate these findings, and these findings may not generalize well to lower-volume practice settings or to surgeons earlier in the learning curve of direct anterior THA.
authors: The Center for Joint Preservation and Reconstruction, North Shore LIJ/Lenox Hill Hospital, 130 E 77th Street, 11th Floor, New York, NY, 10075, USA.
authors: José A
authors: JA
authors: Rodriguez
authors: Ajit J
authors: AJ
authors: Deshmukh
authors: Parthiv A
authors: PA
authors: Rathod
authors: Michelle L
authors: ML
authors: Greiz
authors: Prashant P
authors: PP
authors: Deshmane
authors: Matthew S
authors: MS
authors: Hepinstall
authors: Amar S
authors: AS
authors: Ranawat
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000704:Analysis of Variance; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D001696:Biomechanical Phenomena; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D005260:Female; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
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