Forgotten Joint Score in THA: Comparing the Direct Anterior Approach to Posterior Approach

Abstract

Background: The direct anterior approach (DAA) in total hip arthroplasty (THA) has gained popularity because of potential decreased postoperative pain and quicker recovery after surgery in comparison to the posterior approach (PA). With a growing focus on patient-reported outcome (PRO) measurements after surgery, we sought to determine if one approach led to better PRO scores as determined by the Forgotten Joint Score-12 (FJS-12) questionnaire.

Methods: A retrospective chart review of primary THAs between September 2016 and September 2019 at a single academic hospital was conducted. Demographic and clinical data in addition to FJS-12 scores were collected. Two groups were created based on THA approach. Frequency rates, means, and standard deviations were used to describe baseline patient characteristics. Differences in demographic data were accounted for using linear regression models.

Results: A total of 1469 cases were identified, with 830 using the DAA and 639 the PA. Significant demographic differences were observed between the 2 groups. However, when controlling for this, there were no differences in FJS-12 scores between approaches at 1 and 1.75 years (P = .232 and P = .486, respectively). At 12 weeks, DAA patients had higher satisfaction (59.21 vs 46.8; P = .006). When controlling for surgeon case volume, no differences in FJS-12 were observed at any of the time points (P = .536, P = .452, and P = .967, respectively) CONCLUSION: DAA THA patients trended toward better PRO scores than their PA counterparts. However, when controlling for surgeon case volume, no differences were observed, which suggests that surgeon case volume and experience have an important effect on patient satisfaction and FJS-12 scores.

Keywords: PRO score; THA; direct anterior approach; forgotten joint score; patient-satisfaction; posterior approach.