Abstract
Despite the increasing frequency of younger patients undergoing total hip arthroplasty
(THA), very few, if any, studies report on postoperative outcomes that specifically
compare the two most commonly used approaches in this age group. The purpose of our
study is to assess whether surgical approach affects postoperative outcomes in THA
patients younger than 35 years. A retrospective analysis of 115 patients younger than
35 years that underwent primary unilateral THA between January 2013 and April 2018
was conducted. Patients were divided into two cohorts: (1) patients that underwent
THA utilizing the anterior approach and (2) patients that underwent THA utilizing
the posterior approach. Subanalysis controlling for surgical case complexity and use
of robotic assistance was performed. Radiographic analysis included measurement of
perioperative leg length discrepancies. Of the total 115 patients, 37 were in the
anterior THA cohort, and 78 were in the posterior THA cohort. All baseline patient
characteristics were similar among both cohorts. Patients in the anterior THA cohort
had shorter mean operative times (95 vs. 121 minutes; p < 0.01) and shorter mean hospital length of stay or LOS (1.9 vs. 2.8 days; p < 0.01). Leg length discrepancies, dislocation, revision, and all-cause postoperative
complication rates were similar between both cohorts. When excluding complex cases
and use of robotic assistance (anterior n = 36, posterior n = 39), there was no difference in operative time, LOS, or postoperative outcomes.
Our study suggests that surgically complex patients were more likely to undergo posterior
rather than anterior THA. When controlling for surgical complexity and use of robotic
assistance, no difference between approach with respect to operative time, hospital
LOS, dislocation, revision, and all-cause postoperative surgical complication rates
in THA recipients under 35 years of age was found. The results suggest that the anterior
and posterior approaches can be equally effective for the majority of young THA patients.
Keywords
anterior approach - posterior approach - young patients - postoperative outcomes
