Safety and efficacy of bilateral single-stage direct anterior approach total hip arthroplasty in avascular necrosis: A retrospective Indian study

Total hip arthroplasty (THA) via the direct anterior approach (DAA) has gained prominence in early recovery and reduced postoperative discomfort. However, its safety in executing a single stage bilateral DAA THA is debated. This retrospective study assessed the safety, and outcomes of bilateral single-stage DAA THA in young adults with AVN. A retrospective analysis was conducted on consecutive series of 35 young adults between January 10, 2023, and December 30, 2023, at a tertiary care center in India. Standard protocols, including muscle-sparing techniques, and soft tissue preservation, were followed. Implant selection and fixation methods were based on surgeon preference, and patient-specific factors. The mean age (Male: 94.29%, Female: 5.71%) was 30.82±5.82 years, with an average body mass index of 27.51±5.1 kg/m 2 . The mean operative time combined for both hips was 213.45±22.13 minutes. Postoperative hemoglobin level: 12.12±1.4 g/dL and mean intraoperative blood loss was 374.45±50.2 ml, for both hips combined. The average hospital stay was 2.57 days (time of admission to time of discharge). Within the 90-day postoperative period, one case of allogenic blood transfusion was reported, with no major complications. The Hip Harris Score improved significantly from baseline (mean: 39.38±1.94) to 12 weeks postoperatively (mean: 92.65±1.62, p < 0.001). Bilateral single-stage DAA THA is a safe, and effective treatment for young adults with AVN of the femoral head. The absence of major complications, along with significant improvements in functional outcomes, and patient satisfaction, underscores its promising role in managing AVN-related hip pathology in a single admission by performing simultaneous THA for both hips. • Pioneering study on bilateral single-stage DAA THA, demonstrated high safety and efficacy in young adults with AVN. • Unique focus on young adults aged 18-40, addressing a critical demographic for AVN. • Use of DAA for bilateral THA in a single stage, minimizing soft tissue trauma and enhancing recovery. • High safety profile with no major intraoperative complications and minimal postoperative issues. • Study supports DAA THA as a viable surgical option for AVN in resource-limited settings. • Significant functional improvement with Hip Harris Score increasing from 39.38 to 92.65 at 12 weeks.