Outpatient Hip Safety in an Ambulatory Surgery Center is Independent of Approach

Abstract Background There are few data comparing the direct anterior approach (DAA) and posterior approach (PA) for total hip arthroplasty (THA) in the outpatient setting. The purpose of this study was to compare 90-day complications between the two approaches. We hypothesized that they would be equally safe and effective. Methods Retrospective review identified 432 THAs (346 DAA, 86 PA) performed at a single ambulatory surgery center (ASC). Outcomes compared included demographics, comorbidities, pre-operative and discharge pain scores (VAS), overall time spent in the ASC, overnight stay, emergency room visits, admission, re-operation, and complications within a 90-day period. Results There were no differences in mean pre-operative VAS (DAA 4.7, PA 4.5), mean discharge VAS (DAA 0.8, PA 0.7), overall time spent in the ASC (DAA 9.0 hours, PA 9.3 hours), total number of overnight stays (DAA 0.9%, PA 1.2%), emergency room visits (DAA 1.7%, PA 1.2%), admissions (DAA 1.4%, PA 1.2%), re-operations (DAA 1.4%, PA 1.2%), or complications (DAA 3.5%, PA 2.3%). Conclusion There were no differences in the safety outcomes, and overall there were few complications in the 90-day period, regardless of the surgeon’s preferred approach. This study indicates both DAA and PA are equally safe for THA in the outpatient setting, and the choice of surgical approach should be based on patient and surgeon preference.