Background: Direct anterior approach (DAA) total hip arthroplasty has become increasingly popular over the last decade. This approach aims to minimise tissue damage and improve post-operative recovery. Several studies have reported outcomes and comparisons to other total hip arthroplasty approaches. DAA has been shown to significantly decrease inpatient stay, has a faster time to discontinuation of walking aids and decreased immediate post-operative pain. On the other hand, some studies have mentioned an increased operative time and estimated blood loss. Method: Our study reviews 134 cases of DAA total hip arthroplasty between 2017-2019 performed by a single surgeon. A database was collated with patient demographics, operative time, estimated blood loss, length of stay, length of physiotherapy, walking aids, post-operative pain relief, discharge destination and post-operative complications. Statistical analysis was performed.
Results: Overall length of surgery and blood loss was comparable to other THA approaches. There was a reduced length of stay, decreased pain and analgesia usage and faster discontinuation of walking aids compared to the literature on other approaches. Given our promising results we propose a same day discharge protocol following DAA total hip arthroplasty for pre-selected patients with careful perioperative management.
Conclusion: There is a growing popularity with DAA according to the current literature and our study has shown that it leads to earlier recovery and improved functional benefit. Rapid recovery protocols and less invasive surgery are becoming more widespread and hospital associated cost is also becoming a larger factor in THA. It will be interesting to review outcomes of cases with same day discharge as we maintain patient safety as a priority, improve patient satisfaction as well as cost-efficacy. With further education, we can optimise success for outpatient DAA total hip arthroplasty.