This month’s Journal of Arthroplasty included a paper which received the American Association of Hip and Knee Surgeons Clinical Research Award. This paper is entitled “No Evidence for Superior Patient-Reported Outcome Scores After Total Hip Arthroplasty With the Direct Anterior Approach at 1.5 Month Postoperatively and Through a 5-Year Follow-up. One of the purposes of this study was to provide additional data about this contentious topic with some proponents of the anterior approach claiming faster early recovery after surgery. This topic has been debated widely among both expert surgeons and patients alike.
Comparing 93 matched patients who underwent either a direct anterior or a posterior total hip replacement, the authors found that direct anterior patients were actually less likely to reach an acceptable symptom state at their first postoperative visit and that by 1 year and 5 years there were no differences in improvement or symptom state.
Despite claims that the direct anterior approach leads to less pain, shorter hospital stay and slightly lower risk of dislocation, it should also be known to prospective patients that this approach is also associated with a higher risk of early revision to femoral loosening, a higher risk of sensory nerve damage, and a higher risk of intra operative femur fracture.
Modern rapid recovery protocols can now be applied to any surgical approach to hip replacement and our AVATAR protocol allows immediate full weight bearing, activity progression as tolerated, discontinuation of assistive devices as tolerated and essential no hip precautions. The key to outcomes of hip replacement involve much more than just the surgical approach and include patient general health, body weight, patient motivation, dedication to recovery of strength and function, proper implant position and avoidance of complications.
Our center has the shortest average length of stay of any practice in New Hampshire with nearly 80% of eligible patients going home the same day within hours of their surgery. Our advice to patients is to pick a surgeon whom you trust rather than an approach or an implant. Leave those decisions to the experts and trust that they will use what is best for you.
