The direct anterior approach without traction table: How does it compare with the posterior approach? - A prospective non-randomised trial

Tarun Goyal; Arghya Kundu Choudhury; Souvik Paul; Lakshmana Das; Tushar Gupta

doi:10.1016/j.jcot.2022.101924

The direct anterior approach without traction table: How does it compare with the posterior approach? - A prospective non-randomised trial

J Clin Orthop Trauma. 2022 Jun 21:31:101924. doi: 10.1016/j.jcot.2022.101924. eCollection 2022 Aug.

Authors

Tarun Goyal¹, Arghya Kundu Choudhury², Souvik Paul², Lakshmana Das¹, Tushar Gupta²

Affiliations

¹ Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India.
² Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India.

Abstract

Purpose: The direct anterior approach (DAA) for total hip replacement (THR) is relatively new. It has been proved superior to other techniques concerning early functional outcomes, stability, and earlier recovery. But DAA-THR has a steeper surgical learning curve and, in its original description, needs special operating room equipment. This study aims to present clinical, functional, and radiological outcomes of DAA compared to the posterior approach (PA), performed using a routine operating table and instrumentation sets.

Methods: Eighty patients undergoing THR were non-randomly allocated prospectively into Group 1 DAA and Group 2 PA. Visual analog scale (VAS) for pain was recorded preoperatively and at 6, 12, 24, 48, and 72 h after the surgery and at 1st and 2nd year postoperatively. Both groups' functional outcomes were evaluated pre-and postoperatively at 1st and 2nd-year follow-up with Harris hip score (HHS) and SF-12. Perioperative parameters like blood loss, length of hospital stay, duration of surgery, postoperative complications, and radiological prosthesis positioning were also compared between the two groups.

Results: All patients were comparable according to their baseline demographic characteristics. DAA was found to have significantly better early HHS at one year (p = 0.001) and VAS for hip pain (p < 0.05) at 12, 24, 48, and 72 hrs postoperative period only. Clinical outcomes were comparable at the final follow-up of 2 years. Perioperative variables were also similar except the incision length, length of stay in the hospital, and average time to weight bear without walking aids which were statistically better in DAA than PA group. There was no difference in radiological prosthesis positioning. Postoperative complication rates were also comparable in the two groups.

Conclusion: Though technically demanding, DAA provides better early functional outcomes with comparable radiological outcomes and complication rates than the PA.Level of evidence: Non-randomized comparative trial, Level II.

Keywords: Direct anterior approach (DAA); Early outcomes; Outcomes analysis; Posterior approach (PA); Total hip arthroplasty.