DIRECT ANTERIOR VERSUS POSTEROLATERAL APPROACHES IN TOTAL HIP ARTHROPLASTY: A COMPARATIVE EVALUATION OF EARLY AND LATE CLINICAL OUTCOMES

Objective: The direct anterior approach (DAA) and posterolateral approach (PLA) are commonly used in total hip arthroplasty (THA). This study aimed to compare
these approaches in terms of complication rates and functional outcomes.
Materials and Methods: This retrospective study included 130 patients who underwent THA for primary hip osteoarthritis (DAA: 53; PLA: 77). All patients underwent
preoperative radiological and comorbidity assessments. Clinical outcomes were evaluated using the Harris Hip Score (HHS), University of California Los Angeles (UCLA)
Activity Score, and Visual Analog Scale (VAS) for pain preoperatively, at 3 months, and at final follow-up. Patients were followed at regular intervals for at least 1 year.
Results: There were no significant differences between groups in intraoperative blood loss, transfusion requirements, or hospital stay. Operative time was longer in
the DAA group (p=0.008). The overall complication rate was higher in the DAA group (p=0.049). Both groups showed significant improvement in clinical scores over
time. HHS was significantly higher in the DAA group at 3 months, but this difference diminished at final follow-up. The DAA group demonstrated higher UCLA scores
at final follow-up. Multivariable regression analysis identified preoperative UCLA score as an independent predictor of final UCLA score (B=0.371; p<0.001).
Conclusions: DAA was associated with longer operative time but showed no significant disadvantage in major perioperative outcomes compared to PLA. While DAA
provided an early functional benefit, long-term outcomes were comparable. Final outcomes appeared to be influenced more by patient-related factors than surgical
approach. Therefore, surgical approach selection should be individualized based on patient characteristics and surgeon experience.