A prospective comparison of functional results between direct anterior and posterior approaches in total hip replacement

Introduction Total hip arthroplasty (THA) is highly effective for advanced hip disease, and modern research increasingly compares surgical approaches to optimise recovery and outcomes. The direct anterior approach (DAA) offers muscle-sparing benefits and faster early recovery but is technically demanding with a steeper learning curve. The posterior approach (PA) remains widely used due to familiarity but may carry a higher risk of dislocation. This study prospectively compares outcomes of DAA and PA over one year, evaluating operative time, pain, function, radiographic accuracy, and complications.

The purpose was to determine whether the early recovery advantages reported with DAA persist over one year follow-up and how these benefits compare with the increased technical demands and potential risks associated with the approach.

Materials and Methods This single-centre prospective study (Jan 2024–Jun 2025) compared outcomes of 36 primary THA patients treated with the direct anterior (DAA) or posterior approach (PA). One surgical team performed all procedures using standardised perioperative care. Patients were followed for one year. The assessed parameters were pain (VAS), function (HHS), radiographic accuracy, and complications using blinded evaluation and appropriate statistical analysis.

Results A total of 36 THA patients were enrolled (18 in DAA group and 18 in PA group) with comparable baseline demographics. Operative time was longer in the DAA group, but hospital stay, postoperative pain progression, functional recovery, and radiographic outcomes were similar. Two intraoperative fractures occurred in the PA group and one early infection in the DAA group, all successfully managed. Overall, both approaches showed equivalent one-year outcomes with low complication rates.

Discussion This study compared functional outcomes between the PA approach and DAA approach in hip THR. Both approaches sgowed comparable one-year outcomes; DAA offered earlier recovery but longer operative time, with similar complication rates.

Conclusion Despite longer DAA operative times, both approaches showed similar one-year outcomes, emphasizing that surgeon’s skill and patient selection matter more than approach choice.

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