Direct Anterior versus Posterior Approach for Total Hip Arthroplasty Performed for Displaced Femoral Neck Fractures.

Abstract

To compare perioperative, 90-day, and 1-year postoperative complications and outcomes between the direct anterior approach (DAA) and posterior approach (PA) for total hip arthroplasty (THA) in geriatric patients with displaced femoral neck fractures (FNF). Retrospective Cohort Study. Multicenter Healthcare Consortium. 709 patients > 60 years of age with acute displaced FNF between 2009 and 2021. THA using either DAA or PA. Rates of postoperative complications including dislocations, reoperations, and mortality at 90 days and 1 year postoperatively. Secondary outcome measures included ambulation capacity at discharge, ambulation distance with inpatient physical therapy, discharge disposition, and narcotic prescription quantities (morphine milligram equivalents [MME]). Through a multivariable regression analysis, DAA was associated with significantly shorter operative time ​​(B = -6.89 minutes; 95% CI, -12.84 to -0.93; P = 0.024), lower likelihood of blood transfusion during the index hospital stay (aOR = 0.54; 95% CI, 0.27 to 0.96; P = 0.045), and decreased average narcotic prescription amounts at 90 days (B = -230.45 MME; 95% CI, -440.24 to -78.66; P = 0.035) postoperatively. There were no significant differences in medical complications, dislocations, reoperations, and mortality at 90 days and 1 year postoperatively. When comparing the DAA versus PA for THA performed for displaced FNF, DAA was associated with shorter operative time, a lower likelihood of blood transfusion, and lower 90-day postoperative narcotic prescription amounts. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.