No clinically meaningful difference in 1-year patient-reported outcomes among major approaches for primary total hip arthroplasty.

Abstract

Debate continues around the most effective surgical approach for primary total hip arthroplasty (THA). This study's purpose was to compare 1-year patient-reported outcome measures (PROMs) of patients who underwent direct anterior (DA), transgluteal anterolateral (AL)/direct lateral (DL), and posterolateral (PL) approaches. A prospective consecutive series of primary THA for osteoarthritis (<i>n</i> = 2390) were performed at 5 sites within a single institution with standardised care pathways (20 surgeons). Patients were categorised by approach: DA (<i>n</i> = 913; 38%), AL/DL (<i>n</i> = 505; 21%), or PL (<i>n</i> = 972; 41%). Primary outcomes were pain, function, and activity assessed by 1-year postoperative PROMs. Multivariable regression modeling was used to control for differences among the groups. Wald tests were performed to test the significance of select patient factors and simultaneous 95% confidence intervals were constructed. At 1-year postoperative, PROMs were successfully collected from 1842 (77.1%) patients. Approach was a statistically significant factor for 1-year HOOS pain (<i>p</i> = 0.002). Approach was not a significant factor for 1-year HOOS-PS (<i>p</i> = 0.16) or 1-year UCLA activity (<i>p</i> = 0.382). Pairwise comparisons showed no significant difference in 1-year HOOS pain scores between DA and PL approach (<i>p</i> <i>></i> 0.05). AL/DL approach had lower (worse) pain scores than DA or PL approaches with differences in adjusted median score of 3.47 and 2.43, respectively (<i>p</i> <i><</i> 0.05). Patients receiving the AL/DL approach had a small statistical difference in pain scores at 1 year, but no clinically meaningful differences in pain, activity, or function exist at 1-year postoperative.