Satisfaction in Patients Requesting Contralateral Direct Anterior Approach After Ipsilateral Posterior Total Hip Arthroplasty: A Crossover Study.

Abstract

While direct anterior approach (DAA) total hip arthroplasty (THA) may provide improved early outcomes versus posterior approach (PA), there are few clear differences in long-term objective outcomes. Studies evaluating subjective outcomes are lacking. This study sought to identify patient motivations for pursuing DAA, report whether preoperative expectations were met, and compare patient-reported postoperative experiences between approaches. A 22-question survey was administered to 33 patients who underwent primary PA THA followed by contralateral primary DAA THA by a different surgeon between 2001 and 2023 at a single institution. Subjective outcomes were evaluated in patients who had objectively successful THAs (exclusion criteria included major postoperative complications). The mean time between PA and DAA to survey was 12 and 5 years, respectively. There were 17 patients (52%) who requested contralateral DAA because they expected improved outcomes versus PA, while 16 patients (48%) underwent DAA for scheduling reasons. There were no dislocations, infections, or reoperations after either approach. Mean satisfaction was similar between approaches (P = 0.14). There were 28 patients (85%) who preferred DAA. There were five patients who preferred PA who reported anterior groin pain (n = 2), lateral femoral cutaneous nerve pain (n = 1), delayed wound healing (n = 1), and lower satisfaction (n = 1) in their DAA THA. More patients reported faster recovery after DAA versus PA (n = 26 [79%] versus n = 1 [3%]); six patients (18%) reported no difference (95% confidence interval: 60.6 to 90.4, 0.2 to 17.5, and 7.6 to 36.1, respectively). More patients reported less pain after DAA versus PA (n = 17 [52%] versus n = 3 [9%]); 13 patients (39%) reported no difference (95% confidence interval: 33.9 to 68.8, 2.4 to 25.5, and 23.4 to 57.8, respectively). Of those who requested DAA, 100% had preoperative expectations met, and 88% (n = 15) recommended DAA. Forgotten Joint Score was similar between approaches (P = 0.21). Of those who requested DAA, 88% recommended DAA over PA, although Forgotten Joint Score was equivalent. Patients satisfied with PA will likely also be satisfied if they undergo contralateral DAA THA. IV.