Direct anterior approach versus posterior approach in primary total hip replacement: comparison of minimum 2-year outcomes

Hip Int. 2021 Mar;31(2):166-173. doi: 10.1177/1120700019881937. Epub 2019 Oct 20.


Introduction: The direct anterior approach (DAA) has gained popularity in recent years for total hip arthroplasty (THA). Several authors reported significantly better early outcomes when compared to the posterior approach (PA). Nevertheless, controversy exists regarding longer-term benefits of the DAA.

Methods: Data was prospectively collected and retrospectively reviewed for primary THAs conducted between July 2008 and July 2016. Patients who underwent DAA and PA with minimum 2-year follow-up for Harris Hip Score (HHS), Forgotten Joint Score-12 (FJS-12), Veteran RAND 12 Mental (VR-12 Mental), Veteran RAND 12 Physical (VR-12 Physical), 12-Item Short Form Survey Mental (SF-12 Mental), 12-Item Short Form Survey Physical (SF-12 Physical), visual analogue scale, and patient satisfaction were included. Propensity score matching was performed on the DAA and PA cohorts (1:1) based on the following variables: age, sex, body mass index, and laterality.

Results: 205 DAA hips were satisfactorily matched to 205 PA hips. The DAA group had higher scores at final follow-up for VR-12 Mental (p = 0.0145), VR-12 Physical (p = 0.0236), SF-12 Mental (p = 0.0393), and SF-12 Physical (p = 0.0391). The DAA and PA groups had comparable HHS (p = 0.0737) and FJS-12 (p = 0.2900).

Conclusions: Although the DAA and PA groups had different follow-up periods, both the DAA and PA groups reported favourable outcomes at minimum 2-year follow-up. While both groups achieved comparable scores for the majority of PROs including VAS and patient satisfaction, the DAA group achieved superior quality of life outcomes when compared with a propensity score matched group of PA surgeries.

Keywords: Direct anterior approach; posterior approach; total hip arthroplasty.

MeSH terms

  • Arthroplasty, Replacement, Hip* / adverse effects
  • Hepatitis C, Chronic*
  • Humans
  • Quality of Life
  • Retrospective Studies
  • Treatment Outcome