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Comparable function seen at 6 weeks with direct anterior, posterior approach for THA
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DALLAS — Patients had earlier hospital discharge and better pain relief after undergoing total hip arthroplasty performed with a direct anterior approach vs. a posterior approach; however, no significant differences were seen for subjective or objective function at 6 weeks, according to study results presented here.
“There does appear to be early benefits with direct anterior total hip arthroplasty in terms of the functional milestones,” Cale Jacobs, PhD, said during her presentation at the American Association of Hip and Knee Surgeons Annual Meeting. “The patients are leaving the hospital earlier, they are off the cane earlier and there has been greater pain relief reported, not only in our study, but in other studies, as well, during the first 2 to 6 weeks after surgery.
“However, like the other available literature, we saw that there does not seem to be a long-term benefit demonstrated yet.”
Cale Jacobs
In the ongoing study, a single surgeon completed all of the total hip arthroplasties (THAs), and all patients received the same implant systems. Patient-reported outcomes included modified Harris Hip Score, Lower-Extremity Function Scale, Single Assessment Numeric Evaluation (SANE) score and SF-12.
Of the 51 patients with 6 weeks of follow-up, those randomized to the direct anterior approach had significantly greater blood loss during THA compared with patients in the posterior approach group; however, patients in the direct anterior approach group had a significantly shorter hospital stay, no longer required a cane earlier and had greater pain relief at 6 months, according to Jacobs.
“Regardless of group, the patients demonstrated a significant improvement at 6 weeks when compared with their preoperative scores. However, the anterior approach patients did demonstrate a significantly greater gain in Harris Hip [and] pain scores at 6 weeks,” Jacobs said.
The groups also showed no significant differences in patient-reported functional measures, such as the number of patients who self-reported unlimited walking ability, normal navigation on stairs and no trouble putting on shoes and socks.
There were also no significant differences between the groups for force reduction when rising from a chair, impact forces when stepping down from a step or the number of patients who were able perform a stair descent test at 6 weeks, according to Jacobs.
“Radiographically, there were no differences between the two groups in terms of inclination angle,” she said. “However, there was sign greater anteversion of the cup with the anterior approach.”
Reference:
Jacobs C. Paper #17. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 7-9, 2014; Dallas.
Disclosure: Funding for this project was provided by Biomet.