A prospective cohort study investigating functional recovery in patients with avascular necrosis hip following total hip arthroplasty using a direct anterior versus direct posterior surgical approach in Indian population

Background: This study examines the comparative outcomes of the Direct Anterior Approach (DAA) and Direct Posterior Approach (DPP) in patients undergoing Total Hip Arthroplasty (THA) for Avascular Necrosis of the hip. Methods: A total of thirty patients were divided equally between the two surgical methods, with half number of patients undergoing DAA and half undergoing DPP. Key performance metrics, including Modified Harris Hip Score (MHHS), blood loss, operative time and length of hospital stay, were analysed to determine which approach offered superior postoperative recovery and patient satisfaction. A convenient sampling technique was used in our study. Epi Info 2023 software was used for statistical analysis of data. The study was conducted in Government medical college and associated group of hospitals. The study was conducted from 01/06/2022 to 30/06/2023. Results: It shows that both approaches led to significant improvements in Modified Harris Hip Score (MHHS) postoperatively, with no statistically significant difference in the final hip function at various follow-up intervals. However, DAA required a smaller incision, making it cosmetically favourable but resulted in greater blood loss and longer operative time due to its technical complexity. DPP, on the other hand, was associated with faster operative time and slightly lower blood loss but had a higher risk of postoperative dislocation. Despite these differences, there was no significant difference in hospital stay duration or overall complication rates between the two groups. Conclusions: While both DAA and DPP are effective for THA, the choice of approach may depend on surgeon expertise and patient-specific factors, with DAA offering better cosmetic outcomes and DPP offering a technically easier procedure with fewer blood loss complications. Further long-term studies are suggested to analyse any potential differences in complication rates beyond the early postoperative period.