A prospective cohort study investigating functional recovery in patients with avascular necrosis hip following total hip arthroplasty using a direct anterior versus direct posterior surgical approach in Indian population

Anand Kumar; K. G. Nama; R. P. Meena; Sanjay Singh Rawat

doi:10.18203/issn.2455-4510.IntJResOrthop20243895

Authors

Anand Kumar Department of Orthopedics, Government Medical College, Kota, Rajasthan, India
K. G. Nama Department of Orthopedics, Government Medical College, Kota, Rajasthan, India
R. P. Meena Department of Orthopedics, Government Medical College, Kota, Rajasthan, India
Sanjay Singh Rawat Department of Orthopedics, Government Medical College, Kota, Rajasthan, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20243895

Keywords:

Avascular necrosis, Direct anterior approach, Direct posterior approach, Modified harris hip score

Abstract

Background: This study examines the comparative outcomes of the Direct Anterior Approach (DAA) and Direct Posterior Approach (DPP) in patients undergoing Total Hip Arthroplasty (THA) for Avascular Necrosis of the hip.

Methods: A total of thirty patients were divided equally between the two surgical methods, with half number of patients undergoing DAA and half undergoing DPP. Key performance metrics, including Modified Harris Hip Score (MHHS), blood loss, operative time and length of hospital stay, were analysed to determine which approach offered superior postoperative recovery and patient satisfaction. A convenient sampling technique was used in our study. Epi Info 2023 software was used for statistical analysis of data. The study was conducted in Government medical college and associated group of hospitals. The study was conducted from 01/06/2022 to 30/06/2023.

Results: It shows that both approaches led to significant improvements in Modified Harris Hip Score (MHHS) postoperatively, with no statistically significant difference in the final hip function at various follow-up intervals. However, DAA required a smaller incision, making it cosmetically favourable but resulted in greater blood loss and longer operative time due to its technical complexity. DPP, on the other hand, was associated with faster operative time and slightly lower blood loss but had a higher risk of postoperative dislocation. Despite these differences, there was no significant difference in hospital stay duration or overall complication rates between the two groups.

Conclusions: While both DAA and DPP are effective for THA, the choice of approach may depend on surgeon expertise and patient-specific factors, with DAA offering better cosmetic outcomes and DPP offering a technically easier procedure with fewer blood loss complications. Further long-term studies are suggested to analyse any potential differences in complication rates beyond the early postoperative period.

Metrics

Metrics Loading ...

References

Calandruccio R. Voies d’abord de la hanche. Milano, Barcelona, Bonn. In: Roy-Camille R, Laurin CA, Riley LH, editors, Membre infe´rieur, Atlas de Chirugie orthope´dique. Paris: Masson; 1991;3:65–70.

Mast NH, Laude F. Revision total hip arthroplasty performed through the hueter interval. J Bone Joint Surg Am. 2011;93(2):143-8.

Berend KR, Lombardi AV, Seng BE, Adams JB. Enhanced early outcomes with the anterior supine intermuscular approach in primary total hip arthroplasty. J Bone Joint Surg Am. 2009;91(6):107–20.

Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty. 2013;28(9):1634–8.

Zhao HY, Kang PD, Xia YY, Shi XJ, Nie Y, Pei FX. Comparison of early functional recovery after total hip arthroplasty using a direct anterior or posterolateral approach: a randomized controlled trial. J Arthroplasty. 2017;32(11):3421–8.

Moerenhout K, Derome P, Laflamme GY, Leduc S, Gaspard H, Benoit B. Direct anterior versus posterior approach for total hip arthroplasty: a multicentric prospective randomized clinical study. Can J Surg. 2020;63(5):412–7.

Miller LE, Gondusky JS, Bhattacharyya S, Kamath AF, Boettner F, Wright J. Does surgical approach affect outcomes in total hip arthroplasty through 90 days of follow-up? A systematic review with meta-analysis. J Arthroplasty. 2018;33(4):1296–302.

Shah RP, Lauthen D, Geller JA, Cooper HJ. Average operative times for 1,313 primary total hip arthroplasty and 1,300 primary total knee arthroplasty over 39 months are roughly equal to medicare attributed operative times. J Arthroplasty. 2019;34(8):1553–6.

Taunton MJ, Mason JB, Odum SM, Springer BD. Direct anterior total hip arthroplasty yields more rapid voluntary cessation of all walking aids: a prospective, randomized clinical trial. J Arthroplasty. 2014;29(9):169–72.

Singh JA, Schleck C, Harmsen S, Lewallen D. Clinically important improvement thresholds for Harris Hip Score and its ability to predict revision risk after primary total hip arthroplasty. BMC Musculo skelet Disord. 2016;17:256–6.

Higgins BT, Barlow DR, Heagerty NE, Lin TJ. Anterior vs posterior approach for total hip arthroplasty, a systematic review and meta-analysis. J Arthroplasty. 2015;30(3):419–34.

Docter S, Philpott HT, Godkin L, Bryant D, Somerville L, Jennings M, et al. Comparison of intra and post-operative complication rates among surgical approaches in total hip arthroplasty: a systematic review and meta-analysis. J Orthopaed. 2020;20:310-25.

Cheng TE, Wallis JA, Taylor NF, Holden CT, Marks P, Smith CL. A prospective randomized clinical trial in total hip arthroplasty-comparing early results between the direct anterior approach and the posterior approach. J Arthroplasty. 2017;2(3):883–90.

Bergin PF, Doppelt JD, Kephart CJ, Benke MT, Graeter JH, Holmes AS. Comparison of minimally invasive direct anterior versus posterior total hip arthroplasty based on inflammation and muscle damage markers. J Bone Joint Surg Am. 2011;93(15):1392–8.

Christensen CP, Jacobs CA. Comparison of patient function during the first six weeks after direct anterior or posterior total hip arthroplasty (THA): a randomized study. J Arthroplasty. 2015;30(9):94–7.

Taunton MJ, Trousdale RT, Sierra RJ, Kaufman K, Pagnano MW. John Charnley Award: randomized clinical trial of direct anterior and miniposterior approach tha: which provides better functional recovery? Clin Orthop Relat Res. 2018;476(2):216–29.

Seah S, Quinn M, Tirosh O, Tran P. Postoperative opioid consumption after total hip arthroplasty: a comparison of three surgical approaches. J Arthroplasty. 2019;34(11):2676–80.

Wright JG, Swiontkowski MF, Heckman JD. Introducing levels of evidence to the journal. J Bone Joint Surg Am. 2003;85-A(1):1–3.

Higgins BT, Barlow DR, Heagerty NE, Lin TJ. Anterior vs. posterior approach for total hip arthroplasty, a systematic review and meta-analysis. J Arthroplast. 2015;30(3):419–34.

Wang Z, Hou J-z, Wu C-h, Zhou Y-j, Gu X-m, Wang H-h, et al. A systematic review and meta-analysis of direct anterior approach versus posterior approach in total hip arthroplasty. J Orthop Surg Res. 2018;13(1):229.

Jia F, Guo B, Xu F, Hou Y, Tang X, Huang L. A comparison of clinical, radiographic and surgical outcomes of total hip arthroplasty between direct anterior and posterior approaches: a systematic review and meta-analysis. Hip Int. 2018;29(6):584–96.

Meermans G, Konan S, Das R, Volpin A, Haddad FS. The direct anterior approach in total hip arthroplasty. Bone Joint J. 2017;99(6):732–40.

Yue C, Kang P, Pei F. Comparison of direct anterior and lateral approaches in total hip arthroplasty: a systematic review and meta-analysis (PRISMA) Medicine. 2015;94(50):2126–26.

Martin CT, Pugely AJ, Gao Y, Clark CR. A comparison of hospital length of stay and short-term morbidity between the anterior and the posterior approaches to total hip arthroplasty. J Arthroplasty. 2013;28(5):849–54.

Zhao HY, Kang PD, Xia YY, Shi XJ, Nie Y, Pei FX. Comparison of early functional recovery after total hip arthroplasty using a direct anterior or posterolateral approach: a randomized controlled trial. J Arthroplasty. 2017;32(11):3421–8.

De Anta-Diaz B, Serralta-Gomis J, Lizaur-Utrilla A, Benavidez E, Lopez-Prats FA. No differences between direct anterior and lateral approach for primary total hip arthroplasty related to muscle damage or functional outcome. Int Orthop. 2016;40(10):2025–30.

Nistor DV, Caterev S, Bolboaca SD, Cosma D, Lucaciu DOG, Todor A. Transitioning to the direct anterior approach in total hip arthroplasty. Is it a true muscle sparing approach when performed by a low volume hip replacement surgeon? Int Orthop. 2017;41(11):2245–52.

Nistor DV, Bota NC, Caterev S, Todor A. Are physical therapy pain levels affected by surgical approach in total hip arthroplasty? A randomized controlled trial. Orthop Rev (Pavia). 2020;12(1):8399.

Ross D, Erkocak O, Rasouli MR, Parvizi J. Operative time directly correlates with blood loss and need for blood transfusion in total joint arthroplasty. Arch Bone J Surg. 2019;7(3):229–33.