Comparison of direct anterior and posterior approaches in total hip arthroplasty within a mature surgical practice: A single surgeon analysis of complications and perioperative metrics

Objectives: This study aimed to compare complication rates, hospital readmissions, and operative parameters based on surgical approach in a mature total hip arthroplasty (THA) practice. Methods: This retrospective study analyzed cases from a mature THA practice, with all cases performed by a single surgeon. Posterior approach (PA) cases were performed in the period of 2011 through 2013, while direct anterior approach (DAA) cases were performed from 2021 to 2023. Patient demographics, discharge information, and intraoperative parameters were also recorded. Results: DAA THA was associated with a shorter operative time (66.2 min vs. 70.1 min, p = 0.0007) and lower estimated intraoperative blood loss (286.2 mL vs. 315 mL, p < 0.0001) compared to PA THA. There were no significant differences in complication or hospital readmission rates between approaches. Differences in days to discharge were also observed, likely reflecting temporal shifts in practice patterns between the two study periods. Conclusion: The DAA in THA was associated with shorter operative time, fewer days to discharge, and less intraoperative blood loss, with no increase in complications or readmissions compared with the PA. The comparisons in this study were taken from two distinct time periods, which may limit the findings of this study. The surgical approach alone cannot fully account for the findings in this study, given the substantial time difference in the two surgical approaches.