Limited benefits of the direct anterior approach in primary hip arthroplasty: A prospective single centre cohort study.
BACKGROUND
Since years a discussion is held on the best approach to perform total hip replacement (THR). Risk of dislocation, abductor weakness and a possible difference in rehabilitation are mentioned. We performed this study to objectify that the use of the direct anterior approach (DAA) results in a faster rehabilitation after THR compared to the non-DAA (posterolateral and anterolateral) approach.


METHODS
A single centre prospective cohort study was conducted. Pre- and 16-weeks postoperative completed PROMs like the VAS, PSC, GPE and HOOS were analyzed. A leg press and power test were performed. Functional capacity was determined by the TUG and the 6MWT.


RESULTS
A total of 119 patients were included for analysis: 87 in the DAA group, 32 in the non-DAA group. There were no differences in general baseline characteristics. The length of stay was significant (p= .000) shorter in the DAA group. At 16 weeks, the DAA group showed a significant greater improvement with respect to the VAS and HOOS. Also significant differences for all strength, power and functional capacity parameters between the pre- and postoperative measurements were found. A subgroup analysis at 6-weeks postoperative showed significant improvements in the TUG (p= .009) and 6MWT (p= .009) in the DAA group, but not in the non-DAA group.


CONCLUSIONS
PROMs, strength, power and functional capacity tests show significant improvement in all approaches after THR. There seems to be a small advantage in favour of the DAA, in particular directly postoperative and the first postoperative weeks.
Elkerliek Ziekenhuis, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands.
Jetse
J
Jelsma
Physiotherapy Jeurissen & van Ingh, Fabriekstraat 24, 5753 AH Deurne, The Netherlands.
Rik
R
Pijnenburg
Elkerliek Ziekenhuis, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands.
Harm W
HW
Boons
Elkerliek Ziekenhuis, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands.
Peter J M G
PJ
Eggen
Elkerliek Ziekenhuis, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands.
Lucas L A
LL
Kleijn
Elkerliek Ziekenhuis, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands.
Herman
H
Lacroix
Elkerliek Ziekenhuis, Wesselmanlaan 25, 5707 HA Helmond, The Netherlands.
Hub J
HJ
Noten
Anterolateral approach; Direct anterior approach; Direct lateral approach; Posterolateral approach; Primary total hip replacement