Direct anterior versus mini-anterolateral approach for primary total hip arthroplasty: early postoperative outcomes and complications

BACKGROUND: Anterior-based approaches to primary total hip arthroplasty (THA) are being used more frequently, and several variations have been described. The supine direct anterior (DA) approach has been widely studied, but few studies have compared it with the mini-anterolateral (mini-AL) approach (abductor-sparing, Watson-Jones approach) in the lateral decubitus position. This study aims to compare early perioperative complications and outcomes between these 2 approaches. METHODS: This study retrospectively reviewed 340 consecutive THAs (n = 170 DA, n = 170 mini-AL) performed by 3 arthroplasty surgeons at a single institution between January 2017 and May 2018. The primary outcome was reoperation for any reason within 1 year. Secondary outcomes included wound-healing complications and several perioperative factors. A Student’s t-test was used for continuous variables, and a chi-squared test was used for categorical variables. RESULTS: In this cohort, 6 patients (4%) from the mini-AL group required reoperation within 1 year, compared with 2 patients (1%) from the DA group (P = .024). However, the DA group had 13 patients (8%) with wound-healing complications compared with 6 patients (4%) in the mini-AL group 4% (P = .036). Perioperative outcomes were similar for operative time, distance walked with physical therapy, morphine milligram equivalent consumed, length of stay, and discharge disposition. Pain scores during index hospitalization were also similar. CONCLUSIONS: Patients who underwent THA using the supine DA approach had fewer reoperations within 1 year, but more wound-healing complications compared with the mini-AL approach in the lateral decubitus position. For surgeons performing primary THA using an anterior-based approach, relative risks and benefits of these approaches must be understood. LEVEL OF EVIDENCE: Level III.