Abstract
Introduction
The Direct Anterior Approach (DAA) offers potential advantages of quicker rehabilitation compared to posterior approach THR. The aim of this study was to compare hospital based and early clinical outcomes between these two groups with utilisation of Enhanced Recovery After Surgery (ERAS) protocol.
Patients/Materials & Methods
Prospectively collected data for both cohorts were matched for age, gender, ASA grade, BMI, operation side, Pre-operative Oxford Hip score (OHS) and attendance at multi-disciplinary joint school. The pain scores at 0,1,2,3 post-op days, the day of mobilization, inpatient duration, complications, 28 days readmission rates and OHS at 6 and 24 months were compared.
Results
Four hundred and fifty two THR (DAA: 219, Posterior: 233) were matched. There was no difference in OHS at 6 months (p=0.07). There was also no difference in pain scores at 0, 1, 2, and 3rd post op days, the day of first mobilization (p=0.32), length of stay (p= 0.3), 28 days readmission (p=0.11) or OHS at 24 months (p=0. 09). 68% of DAA vs 58 % of posterior approach patients achieved planned in-patient duration target of 3 days (p= 0.04). There were six peri-prosthetic femoral fractures in DAA group vs one in posterior approach group (p=0.097). No significant difference was identified for complications, re-operation or 28 days readmission rates between two groups.
Discussion
The DAA procedures were performed by two surgeons with extensive prior experience in DAA approach. The potential advantages and complications especially during early learning curve have to be carefully considered by operating surgeon who wishes to start performing DAA approach. The ERAS protocol can potentially reduce the difference in early recovery between two groups.
Conclusion
There is no significant difference in clinical outcomes between DAA and posterior approach THR with utilisation of ERAS protocol except potential of discharge from the hospital within three days following the DAA procedure.
