Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: perioperative findings

Abstract

Background: Given the increasing demand for tissue-sparing surgery, the surgical approach is the subject of lively debate in total hip replacement. The aim of this paper is to compare the efficacy of the minimally invasive direct anterior approach and the standard lateral approach to total hip replacement surgery by observing intra- and perioperative outcomes.

Materials and methods: The authors conducted a retrospective study on a group of 419 consecutive patients undergoing total hip replacement for coxarthrosis. The patients were divided into a first group (A) of 198 patients who had surgery with the standard lateral approach, and a second control group (B) of 221 patients who had the same procedure via the minimally invasive direct anterior approach. Assessment of the two groups considered the following perioperative parameters: length of the surgical procedure, intraoperative complications, intra- and postoperative blood loss, postoperative pain, postoperative nausea and vomiting, length of stay, and type of discharge.

Results: The two groups were homogeneous when compared in relation to mean age, sex and body weight. The minimally invasive direct anterior approach was performed within an acceptable time (89 ± 19 min vs. 81 ± 15 min) and with modest blood loss (3.1 ± 0.9 g/dL vs. 3,5 ± 1 g/dL). Patients experienced less pain (1.4 ± 1.5 NRS score vs. 2.5 ± 2 NRS score), and PONV affected only 5% versus 10% of cases. Times to discharge were shorter (7 ± 2 days vs. 10 ± 3.5 days), and 58.4% versus 11.6% of patients were discharged to home.

Conclusions: In our study, patients treated with a minimally invasive direct anterior approach had a better perioperative outcome than patients treated with the lateral approach. The longer time of surgery for the minimally invasive direct anterior approach may be attributed to the learning curve. Further studies are necessary to investigate the advantages of a minimally invasive direct anterior approach in terms of clinical results in the short and long run.

Fig. 1

Patient placed in the supine position on a standard orthopedic bed. The sterile field includes both lower limbs

Fig. 2

Incision starts 2 cm distal to and 2 cm posterior to the ASIS and continues distally for about 8–10 cm along the straight line joining the lateral edge of the patella

Fig. 3

a, bU-shaped medially based capsulotomy. The resulting flap is folded over distally to protect the vessels

Fig. 4

Double osteotomy technique

Fig. 5

Operated limb adducted below the contralateral limb and rotated outward to allow the proximal metaphysis of the femur to protrude