Approach-Based Complication Rates of Total Hip Arthroplasty (THA) in a Medicare Population

Paul J. Tesoriero, Jonathan A. Gabor, Jorge A. Padilla, Ran Schwarzkopf, Roy I. Davidovitch

INTRODUCTION

Although the posterior approach is the most commonly utilized approach in Total Hip Arthroplasty (THA), a push has been made for the anterior approach due to its suggested decreased pain, improved hip stability and rapid recovery following surgery. The aim of this study is to compare the clinical and post-surgical efficacy between the two approaches.

METHODS

A retrospective chart review was performed on 459 Medicare patients who underwent primary THA between October 2016 and September 2017. Descriptive patient characteristics were collected using our electronic data warehouse and included age, sex, race, Body Mass Index (BMI).  Surgical and clinical data was extracted and included readmission status, discharge status, surgical time, surgical site infection, and morphine milligram equivalents (MME) per day. Statistical tests for significance were conducted on log-transformed surgical time and MMEs/day.

RESULTS

228 patients (49.7%) were included in the anterior approach cohort while 231 patients (50.3%) were included in the posterior approach cohort. Discharges to an acute rehabilitation facility as opposed to home occurred in 80% fewer patients in the anterior approach cohort as compared to the posterior approach cohort. MME/day was lower in the anterior approach cohort compared with the posterior approach and trended towards statistical significance (22.7 ± 16.1 MME/day vs. 27.5 ± 26.4 MME/day). There were no statistically significant differences in readmission rates (5% vs, 8%), surgical site infections (0.4% equivalent in both), or surgical time (66.3 ± 18.8 minutes vs. 68.1 ± 22.5 minutes), between the anterior and posterior approaches, respectively.

DISCUSSION AND CONCLUSION

The anterior approach to THA resulted in fewer discharges to acute rehabilitation facilities when compared with the posterior approach. There were no differences in infection rates (0.4%) or readmission rates although increased readmission rates and opiate use trended higher in the posterior group.