Hip Pelvis.  2025 Sep;37(3):205-212. 10.5371/hp.2025.37.3.205.

Comparison of Direct Anterior Approach and Posterolateral Approach in Total Hip Arthroplasty in Elderly People Aged 75 Years or Older

• Park TG
• Chung YY
• Kim YJ
• Kim MS

• KMID: 2571809
• DOI: http://doi.org/10.5371/hp.2025.37.3.205

Abstract

Purpose
The study investigated the benefits of the direct anterior approach (DAA) compared to the posterolateral approach (PLA) in patients over 75 years of age.
Materials and Methods
This study included 144 patients who underwent total hip arthroplasty (THA) from December 2012 to November 2021. Group A had 93 patients with a mean age of 80.8±5.0 years, who underwent DAA. Group B had 51 patients with a mean age of 79.7±4.6 years, who underwent PLA. Clinical outcomes included operative time, time to ambulation, walking ability, and complications.
Results
There were no demographic differences between the groups. The mean age was 80.9±5.0 years in Group A and 80.5±4.8 years in Group B. Mean operative time was 94.2±7.2 minutes in Group A and 91.2±8.8 minutes in Group B (P=0.02). Early ambulation within 3 days postoperatively was seen in 72 patients (77.4%) in Group A and 31 patients (60.8%) in Group B (P=0.03). No significant change was seen in modified Koval Index in Group A (4.35 to 4.06, P=0.51), while Group B showed a significant decrease (4.47 to 3.88, P=0.04). The postoperative modified Koval index negatively correlated with time to ambulation (P=–0.17, P=0.04). Dislocation occurred in 3 patients (3.2%) in Group A and 7 patients (13.7%) in Group B (P=0.02). No differences were found in medical complications or mortality.
Conclusion
THA via DAA may provide earlier functional recovery than PLA, with comparable safety in patients over 75 years of age.

Keyword

Femur; Femoral neck fractures; Osteonecrosis; Arthritis; Total hip arthroplasty