Summary

Short-term mortality rate seemed to be significantly lower following the direct anterior approach for total hip arthroplasty compared to the various other approaches. This difference seemed to be more substantial in healthy patients than in unhealthy patients.

Abstract

Introduction

Currently, the impact of the various surgical approaches in primary total hip arthroplasty (THA) on short-term mortality rates remains largely unexplored. The aim of this study was to compare short-term mortality rates between the direct anterior (DAA), posterolateral (PL), anterolateral (AL) and direct lateral (DL) approaches and determine potential risk factors for early mortality.

Methods

A retrospective cross-sectional registry study was conducted using data from April 2007 to April 2023 of the Dutch Arthroplasty Register. Thirty-day and ninety-day mortality were compared between distinct THA approaches using the Chi2-test and the logistic regression analysis to adjust for confounders. A multivariate logistic regression model was performed to determine the risk factors for short-term mortality.

Results

The study comprised 379.108 patients (mean age 69.9 ± 9.5, male 33.8%). Likelihood on thirty-day mortality was significantly lower for the DAA group compared to the other surgical approaches (DAA 0.064%; AL 0.154%; PL 0.120%; DL 0.145%, p< .001). Ninety-day mortality for DAA (0.17%) was significantly lower than the other THA approaches in ASA I-II patients (AL: 0.29%, OR 2.293, p<.001; PL: 0.26%, OR 1.963, p<.001; DL: 0.28%, OR 2.016, p<.001) but not significant in ASA III-IV patients, except when comparing the DAA to the DL approach (OR 1.484, p=.011). Increased age, male gender, surgical THA approach and cementless fixation were significant risk factors for thirty- and ninety-day mortality.

Conclusion

Short-term mortality rate seemed to be significantly lower following the DAA approach for THA compared to the various other approaches. This difference seemed to be more substantial in healthy patients than in unhealthy patients. Age, gender, Surgical approach, and fixation method demonstrated to be risk factors for short-term mortality and should be considered when deciding on THA.