Pain and rehabilitation after total hip arthroplasty are approach dependent: results 6weeks and 2years after surgery in a multisurgeon, single-center, and prospective cohort study.

Abstract

The aim of this study was the evaluation of pain, function, and overall satisfaction after total hip arthroplasty (THA) using three different standard surgical approaches (DAA (direct anterior approach), lateral, and posterior approach) 2years postoperatively. Additionally, we compared the results with recently published results of the same study population 6weeks postoperatively. In a multisurgeon, prospective, single-center cohort study, a total of initial 188 patients who underwent total hip arthroplasty (THA) between February 2019 and April 2019 were analyzed on pain, function, and satisfaction within the first days, 6weeks, and 2years postoperatively according to three different approaches (DAA, lateral, and posterior approach). Our research group recently published results directly and 6weeks postoperatively. We evaluated the same study collectively 2years postoperatively and compared the results with the data 6weeks postoperatively. One hundred twenty-five patients could be included. Outcome parameters for the present study were the pain level according to the visual analogue scale (VAS), the modified Harris hip score (mHHS), and an overall satisfaction scale 2years postoperatively. Mean overall satisfaction 2years postoperatively was 9.7 ± 1 (3-10). Satisfaction was significantly better for the DAA than for the lateral approach (p = 0.005). There were no significant differences between the lateral and posterior approaches (p = 0.06) and between the DAA and the posterior approaches (p = 0.11). In total, the mean pain level was 0.4 ± 0.9 (0-5) at 6weeks and 0.5 ± 1.1 (0-7) at 2years postoperatively (p = 0.3). Regarding the different approach groups, pain levels 6weeks and 2years postoperatively were significantly lower for the DAA than for the lateral approach (p = 0.02). There were no significant differences between DAA and posterior approach (p = 0.05) and the lateral and posterior approach (p = 0.26). The mean mHHS significantly increased from 84.7 + 14.5 (37.4-100) 6weeks to 95 + 12.5 (23.1-100.1) 2years postoperatively (p < 0.0001). Regarding the different approaches, mHHS was significantly higher for the DAA than for the lateral approach (p = 0.03). Differences between the DAA and the posterior approach (p = 0.11) and between the lateral and posterior approaches (p = 0.24) were insignificant. At 2years postoperative, DAA showed significantly better overall satisfaction, pain level, and mHHS than the lateral approach. The differences between DAA and the posterior approach and lateral and posterior approaches were insignificant. Whether the superior results of the DAA to the lateral approach persist over a longer period must be clarified by further studies. Prospective cohort study, level of evidence 2.