OBJECTIVES: Total hip arthroplasty is used widely around the world as an effective procedure for osteoarthritis. In our clinic total hip arthroplasty is often carried out using the conventional anterolateral approach (AL) and the less invasive direct anterior approach (DAA). The aim of our current study was to evaluate the comparative advantage and physiotherapy rehabilitation of patients undergoing DAA compared to AL surgeries.

METHODS: A retrospective cohort study was conducted for patients scheduled for total hip arthroplasty at the Department of Traumatology and Hand Surgery between July 2016 and September 2017. Mobilization, length of hospitalization, recovery during the early postoperative period, the number of patients admitted home after surgery, physical activity parameters and use of walking aids were evaluated.

RESULTS: Data of eighty-six patients (58 DAA, 28 AL) were evaluated. No significant differences were found between the patient groups with respect to gender, age, BMI and ASA category (p>0.05). Significantly better outcomes were measured in favor of the DAA method during short term acute hospital stay. The length of hospital stay was shorter (mean difference -3.84 days, p<0.001), the necessity of transfusions was lower (32.8% in the DAA group while 64.3% in the AL group, p=0.006), and patient discharge rate was better (63.8% and 35.7% of the patients were discharged home following DAA and AL surgery respectively, p=0.038). It must be noted that aside from the surgical method the length of stay was influenced by the age and the indication (acute/planned) of the surgery, and not by ASA category and BMI.

CONCLUSIONS: Based on our findings and published evidence the early postoperative period benefits favor the DAA method. However, we cannot conclude whether the DAA or the LA approach is superior for total hip arthroplasty, especially when long term benefits are evaluated.