Bilateral simultaneous total hip arthroplasty: comparison of treatment outcome between the direct anterior approach and the posterolateral approach

Background There are many surgical approaches for total hip arthroplasty. In recent years, direct anterior approach (DAA) has been highly praised by many scholars, and it has been widely reported that it has a good curative effect, such as fast recovery. Whether the surgical results and patient satisfaction can reach or exceed the traditional posterolateral approach has been controversial. We hypothesized that the treatment outcome of the direct anterior approach (DAA) approach is superior to the traditional posterolateral approach (PLA). Methods From January 2015 to April 2017, 20 patients (40 hips) were randomly divided into posterolateral approach (PLA) group and direct anterior approach (DAA) group. Record the operation time on both sides, postoperative drainage, prosthesis position, and complications, the functional recovery of hip joint was evaluated by D'Aubigne-Postel score, and the postoperative pain was evaluated by VAS score. Gait parameters were measured before surgery and at 3 and 6 months after surgery, and the patients were asked which side they preferred subjectively after surgery. Results When compared with the PLA group, the DAA group had a shorter incision length (11.4 vs 14.72 cm, P<0.001), shorter intraoperative blood loss (184.05vs 219.00 mL, P<0.001), shorter postoperative drainage volume (105.35 vs 154.10 mL, P<0.001), and lower VAS scores. However, the PLA had shorter operative times (82.20 vs 67.3 min, P<0.001). There was no significant difference in acetabular inclination (39.72 vs 40.92 °, P=0.069), and acetabular anteversion (17.41 vs 17.69°, P=0.663) between the two groups. Joint function recovery: The D'Aubigne-Postel scores of the hip joints in the DAA group vs PLA group at 1, 3, and 6 months after surgery were (8.2, 11.5, 16.5) vs (7.65, 11.45, 16.9). The difference in the 1, 3month was statistically significant (P=0.012, P=0.038), however, this difference disappeared in the 6th month(P=0.072). Conclusions Compared with the PLA, the DAA has the advantages of shorter operation time, smaller incision, less bleeding, less pain, better gait performance and faster recovery of joint function, but patients subjectively preferred the traditional PLA.