Comparison of clinical and economic outcomes between the direct anterior approach and the posterolateral approach for primary total hip arthroplasty
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Orthopaedic and Rehabilitation Center, Warsaw Medical University, Mazowiecki Brodnowski Hospital, Warsaw, Poland
Orthopaedic and Traumatology Clinic, Regional Hospital Kielce, Jan Kochanowski University, Kielce, Poland
Medical Center Enel-Med, Warsaw, Poland
Submission date: 2019-11-18
Final revision date: 2020-02-23
Acceptance date: 2020-03-28
Online publication date: 2020-07-15
Total hip arthroplasty (THA) is one of the most frequently performed surgical procedures in orthopedics. The most commonly employed approaches are the posterolateral approach (PLA) and the lateral approach. Minimally invasive techniques such as direct anterior approach (DAA) and MIS DAA (minimal invasive surgery direct anterior approach) are used more and more often. The aim of the study was to compare the two approaches DAA and PLA in terms of length of stay, economic outcomes, quality of life, hip joint function and hip joint awareness.

Material and methods:
The study was performed as a retrospective analysis of 52 cementless total hip arthroplasty procedures performed by MIS DAA and 56 cementless THA performed by classic standard PLA. The evaluation of hip joint awareness, quality of life, hip joint fitness assessment and economic indicators were evaluated.

The mean duration of the anterior approach procedure (48.96 minutes) was found to be around half that of the posterior approach (102.52 minutes) (Levene’s test: F = 2.37; p > 0.005). The mean durations of the two types of approaches were found to be significantly different (Student’s t test: t (106) = –16.15; p < 0.005). The shorter mean duration of stay and shorter procedure duration associated with the anterior approach result in mean savings of PLN 5465.96 per procedure

The MIS DAA procedure is a safe and less traumatizing surgical approach for hip arthroplasty which allows faster post-operative primary mobilization, shorter procedure time and sooner discharge from hospital than standard PLA. Significant reduction in costs of hospitalization was observed in the MIS DAA procedure.