Title : What's going on in Spain with the direct anterior approach: General trends and our own experience
Abstract:
The direct anterior approach has gained popularity in operating rooms and in recent Spanish scientific literature, which focuses on its advantages of rapid recovery and less muscle damage. The technique is used in the context of the more than 30,000 hip arthroplasties performed annually in Spain, with an upward trend in recent years, although still significantly lower than in other countries such as the US or other European countries. In the last 4 years, the average number of annual publications related to this type of approach has increased from 11 to 25, followed by an increase in the number of surgeries performed anterior approach.
The choice of surgical approach in Total Hip Arthroplasty (THA) directly impacts functional recovery, prosthetic stability, and postoperative complications. Contributing to this cause, we present our study which compares the clinical outcomes of two muscle-sparing techniques: the Direct Anterior Approach (DAA) and the posterior approach (PA) which included Postero Lateral (PL) and Direct Superior Approach (DSA). This is our experience during a 16 month surgery period.
This is a retrospective comparative study of 84 patients who underwent primary THA between November 2022 and February 2024 by 2 different surgeons. They were divided into two groups: DAA (n=53) and PA (n=31)(PL=20)(DSA=11), with a minimum follow-up of 12 months. Evaluated variables included Harris Hip Score (HHS), incidence of dislocations, need for revision surgery, and residual pain level using the Visual Analogue Scale (VAS).
At 12 months, the DAA group showed a mean HHS of 91.2 compared to 88.1 in the PA group (p < 0.05). The dislocation rate was lower in the DAA group (1.9%) compared to the PA group (4.9%), although not statistically significant. One revision due to loosening was recorded in the PA group and none in the DAA group. Residual pain was lower in the DAA group (VAS 1.4 vs 1.8; p < 0.05). Both approaches show good functional results, but the direct anterior approach is associated with better functional recovery, less residual pain, and a lower trend toward mechanical complications. These findings support its use in selected patients, provided it is performed by experienced surgeons.
