Patient-reported Outcomes Following Total Hip Arthroplasty: A Multicenter Comparison Based on Surgical Approaches

Abstract Background Comparisons of patient-reported outcomes (PROs) based on surgical approach for total hip arthroplasty (THA) in the US are limited to series from single surgeons or institutions. Using prospective data from a large, multi-center study, we compare pre to post-operative changes in PROs between posterior, transgluteal, and anterior surgical approaches to THA. Methods Patient-reported function, global health, and pain were systematically collected preoperatively and at one, three, and six months post-operatively from patients undergoing primary THA at 26 sites participating in the Pulmonary Embolism Prevention after Hip and Knee Replacement (PEPPER) trial (ClinicalTrials.gov: NCT02810704). Outcomes consisted of the brief Hip Osteoarthritis Outcomes Survey (HOOS JR.), the Patient-Reported Outcomes Measurement Information System Physical Health score (PROMIS-PH), and the Numeric Pain Rating Scale (NPRS). Operative approaches were grouped by surgical plane relative to the abductor musculature as being either anterior, transgluteal, or posterior. Results Between 12/12/2016 and 08/31/2019, outcomes from 3,018 eligible participants were examined. At one month, the transgluteal cohort had a 2.3 point lower improvement in HOOS JR. (95%CI 0.16-4.39; p=0.035) and a 1.2 point lower improvement in PROMIS-PH (95%CI 0.34-2.14; p=0.007) compared to posterior approaches. There was no significant difference in improvement between anterior and posterior approach. At three and six months, no differences in PRO improvement were observed between groups. Conclusions Patient-reported outcomes 6-months following THA dramatically improved regardless of the plane of surgical approach, suggesting that choice of surgical approach can be left to the discretion of surgeons and patients without fear of differential early outcomes.