Limb Length Discrepancy and Length of Hospital Stay are Better in Total Hip Arthroplasty Done by the Direct Anterior Approach Compared to the Direct Lateral Approach

Purpose: The aim of this study was to compare the limb length discrepancy (LLD), hospital stay, and blood loss following total hip arthroplasty (THA), between patients who underwent THA through a direct anterior approach (DAA) or a direct lateral approach (DLA).

Methods: We assessed retrospectively two cohorts of patients who underwent THA during 2016 and 2017 in our department either in the direct anterior or direct lateral approach. The patients underwent the procedure wither for treatment of hip osteoarthritis or for displaced femoral neck fractures. LLD was assessed by the assistance of a digital x-ray system- PACS. Hospital stay was calculated for the postoperative period till discharge. Blood loss following the procedure was assessed by comparing hemoglobin levels before and after the operation.

Results: 77 patients who were operated in 2016 and 2017 were included. Mean age was 68.8+ 7.8 years. 51 patients were elective patients due to hip osteoarthritis and 26 underwent THA for femoral neck fracture. We divided the cohorts to elective patients and trauma patients.

Patients in the elective group who were operated using the DAA were discharged earlier from the department: 3.11+1.74 vs. 5.12+2.24 (p<0.001). LLD was better in the DAA group among the elective patients 4.23+3.4mm vs. 7.6+7.23mm (p<0.05).

Among trauma patients there was no significant difference in LOS. The LLD was significantly smaller among trauma patients with 3.35+1.63mm vs. 8.87+6.1mm (p<0.01).

We did not find any significant difference in blood loss following surgery between the two approaches in both elective and trauma patients.

Discussion and Conclusions: The main two advantages of the DAA are better LLD and shorter hospital stay. These two issues together with the fast rehabilitation make the DAA a preferable approach over the DLA.