# Early Outcomes After the Adoption of the Direct Anterior Approach for Total Hip Arthroplasty

## TL;DR

This study found that switching to a new surgical method for hip replacement did not lead to worse outcomes and actually improved hospital stay length.

## Contribution

The study provides early evidence on the safety and efficiency of adopting the direct anterior approach for hip surgery during a learning curve.

## Key findings

- Length of hospital stay was significantly shorter with the direct anterior approach.
- No significant differences were found in complication rates or patient-reported outcomes.
- The transition to the new approach did not negatively impact surgical outcomes.

## Abstract

Background and objective

Our unit had historically performed total hip arthroplasty (THA) through either the posterior (PA) approach or the anterolateral approach (ALA). In November 2020, a group of five consultants transitioned to utilising the direct anterior approach (DAA). Appropriate training was undertaken, and cases were performed as dual consultant procedures with intraoperative radiography or robotic assistance. In this study, we aimed to determine if the learning curve of adopting the DAA approach had led to adverse outcomes when compared to the previously used PA or ALA.

Methodology

Outcomes were collated prospectively. These included basic demographics, intraoperative details, complication rates, and Oxford Hip Scores (OHS). The primary outcome measure was OHS. A comparison of outcomes was made across three patient groups who underwent THA either via DAA, PA, or ALA. All patients were operated on between November 2020 and September 2021.

Results

A total of 48 patients underwent DAA THA over one year. The mean age was 67 years and the mean American Society of Anaesthesiologists (ASA) score was 2. Over this period, 140 PA and 137 ALA THAs were performed with available data. Propensity score matching was performed on a 1:1 basis using BMI, age, sex, and ASA scores as covariates to generate a matched cohort group of conventional-approach THA (n=32). Length of stay was significantly reduced at 2.2 days (p<0.001) with DAA compared to ALA and PA. However, there was no significant difference in the length of surgery, blood loss, infection, dislocation, and periprosthetic fracture rate. There was no significant difference in OHS between any approach at three months or one year.

Conclusions

The transition to the DAA approach has not made a negative impact despite its associated steep learning curve and, in fact, has improved efficiency in elective surgery. Based on our findings, we recommend that those shifting to this approach receive the appropriate training in a high-volume centre and perform cases as dual consultant procedures.