Short-term outcomes of the supine muscle-sparing anterolateral versus direct lateral approach to primary total hip arthroplasty

Background: Although total hip arthroplasty (THA) is among the most successful orthopaedic procedures, it is not without complications. As such, finding the optimal surgical approach has become an area of particular interest. In this study, we compare: (1) pain intensity; (2) opioid consumption; (3) lengths of stay (LOS); (4) complication rates; (5) discharge destination; and (6) ambulatory function between patients who underwent THA via the supine muscle-sparing anterolateral (MS-ALA) and conventional direct lateral (DLA) approaches. Methods: A retrospective analysis was conducted on 220 consecutive patients who received primary THA using the supine MS-ALA (n = 101) or DLA (n = 119) between 1 January 2014 and 31 December 2016. Outcomes included postoperative pain intensity, opioid consumption, LOS, discharge destination, complications, additional procedures, and time to independent ambulation. Results: We demonstrated significantly lower opioid consumption on postoperative days (POD) 1 and 2 (mean differences, -32.0 and -28.4 mg, respectively; p 0.001) and decreased pain intensity during the second 24 hours of the hospital stay (mean difference, -22.0; p < 0.001) in patients receiving the MS-ALA. Relative to the DLA cohort, patients in the MS-ALA cohort were 2.04 times more likely to be discharged to home (p = 0.028) and 1.91 times less likely to experience postoperative abductor insufficiency (p = 0.039). Conclusion: The present study is the 1st to compare postoperative outcomes, particularly pain intensity and opioid consumption, between the supine muscle-sparing anterolateral and direct lateral THA approaches. Further research should investigate the effect of surgical approach on quality and cost of care, include larger sample sizes, and involve longer-term follow-up.