Document Type

Conference Proceeding

Publication Date

3-10-2025

Abstract

INTRODUCTION: The effects of surgical approach in total hip arthroplasty (THA) are often debated. Here we compare patients who underwent THA through a posterior versus anterior approach and compared clinical outcomes and patient reported outcome measures (PROMs). METHODS: All primary THAs between January 2016 and December 2022 were obtained retrospectively from a prospective institutional database utilized for contribution to a state-wide joint arthroplasty database. Prospective data was abstracted including baseline demographics, select medical comorbidities, intraoperative variables, postoperative course/complications and patient reported outcomes. Two cohorts were developed based on approach: anterior (aTHA) and posterior (pTHA) THA. Cohort groups were compared utilizing Student’s unpaired t-test for continuous variables and χ2 test for categorical variables. p< .05 was deemed statistically significant. RESULTS: Of 10,881 THAs, there were 3,781 (34.7%) aTHAs and 7,100 (65.3%) pTHAs. aTHA weighed less (80.15±17.16 vs 89.44±22.60 kg; p< 0.01), had lower BMIs (27.81±4.75 vs 30.89±6.55; p< 0.01), less likely to be a type 2 diabetic (9.71 % vs 15.62%; p< 0.01), less likely to be current smokers (10.61% vs 12.11%; p< 0.01), and more likely to be ASA ≤2 (63.9 % vs 49.42%; p< 0.01). Perioperatively, aTHAs had a significantly longer surgical times (90.28±25.91 vs 65.31±24.97 minutes; p< 0.01), shorter length of stay (1.22±1.24 vs 1.73±1.46 days; p< 0.01), and more likely to be discharged home (94.31% vs 89.61%; p< 0.01). aTHAs had a significantly lower rate of intraoperative fractures (0.19% vs 0.62%; p< 0.01). All-cause 90-day events were also lower (10.08% vs 13.82%; p< 0.01). 90-day events included dislocations (0.32% vs 0.85%; p< 0.01), emergency department visits (5.71% vs 7.92%; p< 0.01), readmissions (3.15% vs 5.15%; p< 0.01), reoperations (1.43% vs 2.79%; p< 0.01), hematomas (0.48% vs 1.39%; p< 0.01), and prosthetic joint infections (0.13% vs 0.87%; p< 0.01). There was no difference in 90-day postoperative fractures, DVT/pulmonary embolism, or 90-day death. aTHA had significantly higher HOOS preoperative scores (50.58±13.96 vs 47.31±14.72; p< 0.01), HOOS postoperative scores (80.73±14.65 vs 78.89±15.40; p< 0.01) and last reported HOOS scores (80.49±19.74 vs 78.51±20.68; p< 0.01). DISCUSSION AND CONCLUSION: aTHAs were noted to have shorter LOS, less opioids at discharge, higher discharge rate home and lower 90-day postoperative events. This is in opposition to the current body of literature. This may be secondary to patient selection, surgeon experience, and/or institutional experience. Further research is warranted.

Comments

AAOS American Academy of Orthopaedic Surgeons 2025 Annual Meeting, March 10-14, 2025, San Diego, CA

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