BACKGROUND

The direct anterior approach (DAA) to total hip arthroplasty (THA) has increased in popularity, given the potential for improved post-operative recovery. Patient selection is cited as a factor in complication rates compared to the posterior approach (PA). We compared complications by approach, controlling for relevant baseline characteristics.

METHODS

This is a secondary data analysis from a prospective cohort patient study prescribed a smartphone-based care management platform following THA. Baseline patient characteristics were collected pre-operatively and included in logistic regression models investigating the impact of surgical approach with THA-related adverse events including intraoperative periprosthetic fracture, delayed wound healing, and revision surgery.

RESULTS

In total, 1722 patients were included in analysis; 664 (37.4%) underwent THA via DAA. Pre-operative characteristics including age, HOOS JR, and sex were similar between approach groups, patients undergoing anterior THA had lower comorbidities (p = 0.04) and BMI (p = 0.015). Considering baseline characteristics, anterior approach was associated with reduced odds of revision (OR 0.37, 95%CI 0.12-0.90, p = 0.045). Delayed wound healing occurred more frequently in the anterior approach (OR 3.03, 95%CI 1.39-6.97, p = 0.006), and was associated with BMI (OR 1.10, 95% CI 1.04-1.17, p = 0.002).

CONCLUSIONS

This data demonstrated the DAA was associated with lower odds of revision and an increased risk of delayed wound healing. These must be considered when determining the surgical approach, particularly given the effects of BMI on wound healing.