A randomised trial comparing spatio-temporal gait parameters after total hip arthroplasty between the direct anterior and direct lateral surgical approaches

Introduction: Total hip arthroplasty (THA) is a successful procedure for relieving symptoms of severe osteoarthritis. Surgical approach is a key factor in early recovery and although controversial, little has been written about the direct anterior (DA) approach using objective early measures. Methods: 78 participants were prospectively enrolled to undergo a THA through either a DA or direct lateral (DL) surgical approach. Outcome measures were collected preoperatively and at discharge from the hospital, and 2-, 6- and 12-weeks. Outcome measures included the GAITRite (R) system to measure gait velocity, stride length, single-limb support and single-limb support symmetry. At each time point participants also completed the Timed Up and Go (TUG), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), 12-Item Short-Form Survey (SF-12), Harris Hip Score, and pain visual analog scale (VAS). Results: We found statistically significant differences in gait velocity at discharge, 2-weeks and 6-weeks in favour of the DA group (all p < 0.01). We also found significant differences in favour of the DA group for single-limb support symmetry at 6-weeks (p < 0.01) and 12-weeks (p < 0.01). The time to complete the TUG test was also significantly shorter in the DA group at 2-weeks (p < 0.01) and 6-weeks (p < 0.01) compared to the DL group. However, there were no statistically significant differences in any of the patient-reported outcomes. Conclusion: The DA surgical approach was found to offer significant early advantages in function compared to the DL group, with no differences in quality of life or pain.