Improved perioperative outcomes with direct anterior approach total hip arthroplasty in a Veteran's Affairs patient population

Abstract Background A trend toward improved perioperative outcomes with direct anterior approach total hip arthroplasty (DAA THA) in comparison to posterior approach THA has been described. The benefits of the DAA THA have not been examined in the Veteran's Affairs (VA), a health system unique in its highly comorbid patient demographic and federally subsidized budget. Optimizing outcomes in this population could help reduce costs, readmissions, and complications. This study sought to compare the perioperative and radiographic outcomes of veterans who underwent a DAA THA versus a posterior approach THA. Methods We retrospectively reviewed the records of 110 primary posterior approach THAs and 93 primary DAA THAs performed for primary osteoarthritis by a single surgeon at a VA hospital between 2012 and 2018. We compared mean surgical duration, intraoperative blood loss, perioperative blood transfusion requirements, discharge disposition, hospital length of stay, as well as acetabular component inclination, femoral offset discrepancy, and leg length discrepancy using postoperative anteroposterior pelvis radiographs. Results The DAA group demonstrated significantly lower perioperative blood transfusion rates (5% vs. 20%), increased likelihood of discharge prior to postoperative day three (OR 2.12; 95% CI 1.02–4.44), and higher rate of discharge to home (65% vs. 40%). Acceptable acetabular inclination rate was higher in the DAA group (83% vs. 37%). Conclusion Among veterans undergoing primary THA at a VA hospital, patients undergoing DAA THA had better perioperative outcomes than patients treated with the posterior approach despite similar demographics, American Society of Anesthesiologists score, and the DAA learning curve.