Comparison of Direct Anterior Approach and Posterolateral Approach in Total Hip Arthroplasty in Elderly People Aged 75 Years or Older

Abstract

Purpose: The study investigated the benefits of the direct anterior approach (DAA) compared to the posterolateral approach (PLA) in patients over 75 years of age. Materials and Methods: This study included 144 patients who underwent total hip arthroplasty (THA) from December 2012 to November 2021. Group A had 93 patients with a mean age of 80.8±5.0 years, who underwent DAA. Group B had 51 patients with a mean age of 79.7±4.6 years, who underwent PLA. Clinical outcomes included operative time, time to ambulation, walking ability, and complications. Results: There were no demographic differences between the groups. The mean age was 80.9±5.0 years in Group A and 80.5±4.8 years in Group B. Mean operative time was 94.2±7.2 minutes in Group A and 91.2±8.8 minutes in Group B (P=0.02). Early ambulation within 3 days postoperatively was seen in 72 patients (77.4%) in Group A and 31 patients (60.8%) in Group B (P=0.03). No significant change was seen in modified Koval Index in Group A (4.35 to 4.06, P=0.51), while Group B showed a significant decrease (4.47 to 3.88, P=0.04). The postoperative modified Koval index negatively correlated with time to ambulation (P=–0.17, P=0.04). Dislocation occurred in 3 patients (3.2%) in Group A and 7 patients (13.7%) in Group B (p=0.02). No differences were found in medical complications or mortality. Conclusion: THA via DAA may provide earlier functional recovery than PLA, with comparable safety in patients over 75 years of age.