Title:
Functional Outcomes Following Direct Anterior Approach to Hip Resurfacing Arthroplasty

Authors: Ilan Y. Mitchnik, MD; Addy S. Brandstetter, MD; Johnathan G. Silberzweig, MSc; Ofir Vinograd, MD; Noam Shohat, MD

Background

The direct anterior approach (DAA) for hip arthroplasty is gaining attention due to its muscle-sparing potential, as it avoids detachment of muscles from the bone. Despite its theoretical advantages of minimizing soft tissue trauma, DAA's technical complexity and the associated learning curve pose challenges. Hip resurfacing using DAA is not a common procedure. Moreover, functional outcomes and complications specific to this approach in hip resurfacing are not well-defined in the current literature.

Methods

We conducted a retrospective review of our first eight hip resurfacing arthroplasty cases performed using the DAA. Key operative characteristics, complication rates, and early functional outcomes were assessed. Functional outcomes were measured using the Forgotten Joint Score questionnaire (FJS-12). These results were compared with published data on DAA total hip arthroplasty.

Results

All eight patients were male, with a median age of 58 years (IQR = 47 to 60). The average BMI was 26.9 (SD = 2.8), and the average Charlson Comorbidity Index was 1.5 (SD = 0.9). The median follow-up period was 17 months (IQR = 10 to 20). Four surgeries were conducted under general anesthesia, while the remaining four were performed with spinal anesthesia. The mean operative time was 1 hour and 58 minutes, with an average blood loss of 118 ml. The average postoperative length of hospital stay was 2.25 days. One patient experienced a periprosthetic base of neck fracture requiring revision to total hip arthroplasty. The average FJS-12 score was 67.3 out of 100 points (SE = 14.4), comparable to the reported average score for DAA total hip arthroplasty (67.5/100, SE = 1.1).

Conclusion

The direct anterior approach for hip resurfacing arthroplasty is a feasible technique with a manageable complication profile. Early functional outcomes, as measured by patient-reported outcome scores, are comparable to those observed in total hip arthroplasties performed using the same approach. These findings suggest that the DAA may be a viable option for hip resurfacing, offering similar benefits in terms of patient satisfaction and joint functionality.