Does patient-reported perception of pain differ based on surgical approach in total hip arthroplasty?

Abstract

Whether patient-reported pain differs among surgical approaches in total hip arthroplasty (THA) remains unclear. This study's purposes were to determine differences in pain based on surgical approach (direct anterior (DA) <i>vs</i> posterolateral (PL)) and PL approach incision length. This was a retrospective investigation from two centres and seven surgeons (three DA, three PL, one both) of primary THAs. PL patients were categorized for incision length (6 cm to 8 cm, 8 cm to 12 cm, 12 cm to 15 cm). All patients had cementless femoral and acetabular fixation, at least one year's follow-up, and well-fixed components. Patients completed a pain-drawing questionnaire identifying the location and intensity of pain on an anatomical diagram. Power analysis indicated 800 patients in each cohort for adequate power to detect a 4% difference in pain (alpha = 0.05, beta = 0.80). A total of 1848 patients (982 DA, 866 PL) were included. PL patients were younger (59.4 years, sd 12.9 <i>vs</i> 62.7 years, sd 9.7; p < 0.001) and had shorter follow-up (3.3 years, sd 1.3 <i>vs</i> 3.7 years, sd 1.3; p < 0.001). DA patients reported decreased moderate to severe trochanteric (14% <i>vs</i> 21%; p < 0.001) and groin pain (19% <i>vs</i> 24%; p = 0.004) than PL patients. There were no differences in anterior, lateral, or posterior thigh, back, or buttock pain between cohorts (p = 0.05 to 0.7). PL approach incision length did not impact the incidence or severity of pain (p = 0.3 to 0.7). A significant proportion of patients perceive persistent pain following THA regardless of approach. DA patients reported less trochanteric and groin pain <i>versus</i> PL patients. PL incision length did not influence the incidence or severity of patient-reported pain. Cite this article: <i>Bone Joint J</i> 2019;101-B(6 Supple B):31-36.