Direct Anterior Approach Total Hip Arthroplasty: An Adjunct to an Enhanced Recovery Pathway: Outcomes and Learning Curve Effects in Surgeons Transitioning From Other Surgical Approaches.

BACKGROUND: The aim of this study was to investigate whether the direct anterior approach (DAA) to total hip arthroplasty (THA) resulted in a shorter length of stay (LOS) in surgeons new to the approach when compared to their previously used approach. Perioperative complications were also assessed.

METHODS: We examined 93 DAA THA performed by 3 hip arthroplasty surgeons at a single institution comparing these to their previous 166 operations performed using the lateral or posterior approach.

RESULTS: Fixed-effects generalized linear modeling demonstrated that patients who underwent THA by the DAA had 26% shorter LOS than those who were operated on using lateral or posterior approaches (adjusted risk ratio = 0.74; 95% confidence interval = 0.65-0.84; P < .001). A greater proportion of DAA patients were discharged directly home (98% vs 87%, F (1,233) = 8.12, P = .005) and complication rates were comparable between groups.

CONCLUSION: The DAA can reduce patient LOS and may be a valuable addition to enhanced recovery pathways. Our findings also suggest that surgeons transitioning to the DAA do not have an increased complication rate when compared to their previous approach.