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Effect of anterior approach compared to posterolateral approach on readiness for discharge and thrombogenic markers in patients undergoing unilateral total hip arthroplasty: a prospective cohort study

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The direct anterior approach (DAA) for total hip arthroplasty (THA) is considered less invasive than the posterolateral approach (PLA), possibly leading to earlier mobilization, faster recovery, and lower levels of thrombogenic markers. The purpose of the current study was to prospectively compare readiness for discharge, rehabilitation milestones, markers of thrombosis and inflammation at 6 weeks postoperatively between DAA and PLA.

Methods

A total of 40 patients (20 anterior and 20 posterolateral) were prospectively enrolled. Readiness for discharge, length of stay (LOS), and related outcomes were additionally documented. Blood was drawn at baseline, wound closure, 5-h post-closure, and 24-h post-closure for assays of interleukin-6 (IL-6), PAP (plasmin anti-plasmin), a marker of fibrinolysis, and PF1.2 (Prothrombin fragment 1.2), a marker of thrombin generation.

Results

Compared to the PLA group, the DAA group was ready for discharge a mean 13 h earlier (p = 0.03), while rehabilitation milestones were met a mean 10 h earlier (p = 0.04), and LOS was 13 h shorter (p = 0.02) on average. Pain scores at all study timepoints and patient satisfaction at 6 weeks were similar (p > 0.05). At 24 h postoperatively, PAP levels were 537.53 ± 94.1 µg/L vs. 464.39 ± 114.6 µg/L (p = 0.05), and Il-6 levels were 40.94 ± 26.1 pg/mL vs. 60.51 ± 33.0 pg/mL (p = 0.03), in DAA vs. PLA, respectively.

Conclusions

In the immediate postoperative period, DAA patients were ready for discharge before PLA patients. DAA patients had shorter LOS, a lower inflammatory response, and higher systemic markers of fibrinolysis. However, these differences may not be clinically significant. Future studies with larger study populations are warranted to confirm the validity and significance of these findings.

Level of evidence

Level II, Therapeutic Study.

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Funding

No funding was obtained for this study.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Hospital for Special Surgery, 535 E. 70th Street, New York, NY, 10021, USA

    Kyle N. Kunze, Alexander S. McLawhorn, Michael M. Alexiades, Natasha A. Desai & Thomas P. Sculco

  2. Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA

    Kethy M. Jules-Elysee, Yi Lin & Jonathan C. Beathe

  3. Department of Epidemiology and Biostatistics, George Washington University, Washington, DC, USA

    Yan Ma & Wei Zhang

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  1. Kyle N. Kunze
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  2. Alexander S. McLawhorn
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  5. Natasha A. Desai
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  10. Thomas P. Sculco
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Corresponding author

Correspondence to Kyle N. Kunze.

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Conflict of interest

KMJ, ASM, KNK, MMA, NAD, YL, JCB, YM, WZ, and TPS: no conflicts of interest.

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Institutional board approval was obtained from The Hospital for Special Surgery prior to conducting this study.

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Kunze, K.N., McLawhorn, A.S., Jules-Elysee, K.M. et al. Effect of anterior approach compared to posterolateral approach on readiness for discharge and thrombogenic markers in patients undergoing unilateral total hip arthroplasty: a prospective cohort study. Arch Orthop Trauma Surg 143, 2217–2226 (2023). https://doi.org/10.1007/s00402-022-04484-4

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