Do Patients With Higher Preoperative Functional Outcome Scores Preferentially Seek Direct Anterior Approach Total Hip Arthroplasty?
Background: There is focus on the direct anterior approach (DAA) for total hip arthroplasty because of perceived postoperative functional improvement. We compared baseline, short-term, and long-term outcomes between the DAA and the posterior approach focusing on baseline function. Material and metho...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-08-01
|
| Series: | Arthroplasty Today |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344121000911 |
| _version_ | 1818907659247550464 |
|---|---|
| author | Wayne E. Moschetti, MD, MS Samuel Kunkel, MD, MS Benjamin J. Keeney, PhD David Jevsevar, MD, MBA |
| author_facet | Wayne E. Moschetti, MD, MS Samuel Kunkel, MD, MS Benjamin J. Keeney, PhD David Jevsevar, MD, MBA |
| author_sort | Wayne E. Moschetti, MD, MS |
| collection | DOAJ |
| description | Background: There is focus on the direct anterior approach (DAA) for total hip arthroplasty because of perceived postoperative functional improvement. We compared baseline, short-term, and long-term outcomes between the DAA and the posterior approach focusing on baseline function. Material and methods: Multivariate linear and logistic regression models were used to analyze prospective data on 1457 total hip arthroplasties comparing baseline characteristics, operative time, 90-day reoperation, length of stay (LOS), extended LOS (>3 days), and facility discharge. The Patient-Reported Outcome Measurement Information System-Global Health (PROMIS-10) was used to determine physical component score (PCS) and mental component score (MCS), with clinically significant improvement defined as >5 points. Adjusters included age, sex, race/ethnicity, year, Charlson Comorbidity Index, body mass index, alcohol, and tobacco use. Results: DAA patients had higher preoperative MCS (DAA 50.4 vs posterior approach 47.4, P < .001), PCS (40.7 vs 38.5, P < .001), and postoperative PCS scores (48.9 vs 46.7, P < .001). There was no difference in mean PCS improvement (8.1 vs 8.2; P = .798) or clinically significant PCS change (P = .963). DAA was associated with shorter LOS by 0.49 days (95% confidence interval [CI] = 0.32-0.65, P < .001), lower odds of extended LOS (odds ratio = 0.33, 95% CI = 0.21-0.50, P < .001), and lower odds of facility discharge (odds ratio = 0.54, 95% CI = 0.37-0.79, P < .001). No difference in operative time (86 vs 87 minutes; P = .812) or 90-day reoperations (1 vs 1%; P = .347) was observed. Conclusion: DAA patients presented with higher preoperative PCS and MCS scores, yet both groups experienced significant improvement. DAA was associated with decreased LOS and lower odds of extended LOS and facility discharge. There was no difference in operative time or reoperation. |
| first_indexed | 2024-12-19T21:58:38Z |
| format | Article |
| id | doaj.art-69db18854deb4e3d879e94b40db4d0c5 |
| institution | Directory Open Access Journal |
| issn | 2352-3441 |
| language | English |
| last_indexed | 2024-12-19T21:58:38Z |
| publishDate | 2021-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj.art-69db18854deb4e3d879e94b40db4d0c52022-12-21T20:04:13ZengElsevierArthroplasty Today2352-34412021-08-0110611Do Patients With Higher Preoperative Functional Outcome Scores Preferentially Seek Direct Anterior Approach Total Hip Arthroplasty?Wayne E. Moschetti, MD, MS0Samuel Kunkel, MD, MS1Benjamin J. Keeney, PhD2David Jevsevar, MD, MBA3Department of Orthopaedics, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Corresponding author. One Medical Center Drive, Lebanon, NH, 03756, USA. Tel.: +1 603-650-5133.Department of Orthopaedics, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USABerkley Medical Management Solutions, Overland Park, KS, USADepartment of Orthopaedics, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USABackground: There is focus on the direct anterior approach (DAA) for total hip arthroplasty because of perceived postoperative functional improvement. We compared baseline, short-term, and long-term outcomes between the DAA and the posterior approach focusing on baseline function. Material and methods: Multivariate linear and logistic regression models were used to analyze prospective data on 1457 total hip arthroplasties comparing baseline characteristics, operative time, 90-day reoperation, length of stay (LOS), extended LOS (>3 days), and facility discharge. The Patient-Reported Outcome Measurement Information System-Global Health (PROMIS-10) was used to determine physical component score (PCS) and mental component score (MCS), with clinically significant improvement defined as >5 points. Adjusters included age, sex, race/ethnicity, year, Charlson Comorbidity Index, body mass index, alcohol, and tobacco use. Results: DAA patients had higher preoperative MCS (DAA 50.4 vs posterior approach 47.4, P < .001), PCS (40.7 vs 38.5, P < .001), and postoperative PCS scores (48.9 vs 46.7, P < .001). There was no difference in mean PCS improvement (8.1 vs 8.2; P = .798) or clinically significant PCS change (P = .963). DAA was associated with shorter LOS by 0.49 days (95% confidence interval [CI] = 0.32-0.65, P < .001), lower odds of extended LOS (odds ratio = 0.33, 95% CI = 0.21-0.50, P < .001), and lower odds of facility discharge (odds ratio = 0.54, 95% CI = 0.37-0.79, P < .001). No difference in operative time (86 vs 87 minutes; P = .812) or 90-day reoperations (1 vs 1%; P = .347) was observed. Conclusion: DAA patients presented with higher preoperative PCS and MCS scores, yet both groups experienced significant improvement. DAA was associated with decreased LOS and lower odds of extended LOS and facility discharge. There was no difference in operative time or reoperation.http://www.sciencedirect.com/science/article/pii/S2352344121000911Total hip arthroplastyDirect anterior approachPosterior approachPROMIS-10Health related quality of life |
| spellingShingle | Wayne E. Moschetti, MD, MS Samuel Kunkel, MD, MS Benjamin J. Keeney, PhD David Jevsevar, MD, MBA Do Patients With Higher Preoperative Functional Outcome Scores Preferentially Seek Direct Anterior Approach Total Hip Arthroplasty? Arthroplasty Today Total hip arthroplasty Direct anterior approach Posterior approach PROMIS-10 Health related quality of life |
| title | Do Patients With Higher Preoperative Functional Outcome Scores Preferentially Seek Direct Anterior Approach Total Hip Arthroplasty? |
| title_full | Do Patients With Higher Preoperative Functional Outcome Scores Preferentially Seek Direct Anterior Approach Total Hip Arthroplasty? |
| title_fullStr | Do Patients With Higher Preoperative Functional Outcome Scores Preferentially Seek Direct Anterior Approach Total Hip Arthroplasty? |
| title_full_unstemmed | Do Patients With Higher Preoperative Functional Outcome Scores Preferentially Seek Direct Anterior Approach Total Hip Arthroplasty? |
| title_short | Do Patients With Higher Preoperative Functional Outcome Scores Preferentially Seek Direct Anterior Approach Total Hip Arthroplasty? |
| title_sort | do patients with higher preoperative functional outcome scores preferentially seek direct anterior approach total hip arthroplasty |
| topic | Total hip arthroplasty Direct anterior approach Posterior approach PROMIS-10 Health related quality of life |
| url | http://www.sciencedirect.com/science/article/pii/S2352344121000911 |
| work_keys_str_mv | AT wayneemoschettimdms dopatientswithhigherpreoperativefunctionaloutcomescorespreferentiallyseekdirectanteriorapproachtotalhiparthroplasty AT samuelkunkelmdms dopatientswithhigherpreoperativefunctionaloutcomescorespreferentiallyseekdirectanteriorapproachtotalhiparthroplasty AT benjaminjkeeneyphd dopatientswithhigherpreoperativefunctionaloutcomescorespreferentiallyseekdirectanteriorapproachtotalhiparthroplasty AT davidjevsevarmdmba dopatientswithhigherpreoperativefunctionaloutcomescorespreferentiallyseekdirectanteriorapproachtotalhiparthroplasty |