Assessment of Early Gait Recovery After Anterior Approach Compared to Posterior Approach Total Hip Arthroplasty: A Smartphone Accelerometer-Based Study

Background: The influence of total hip arthroplasty surgical approach on postoperative recovery is not well understood and often debated. This study compares anterior and posterior approach (PA) gait and patient-reported Hip Osteoarthritis Outcome scores (HOOS) in the early phases of recovery. Methods: A prospective study evaluated 20 control subjects, 35 direct anterior approach (DAA), and 34 PA total hip arthroplasty patients. Subjects were assessed preoperatively and at 1 and 4 months post-operatively with HOOS and smartphone gait assessments of gait speed, step length, cadence, step symmetry, and horizontal and vertical center of mass displacements. Results: The DAA and PA groups were not different in baseline HOOS or gait characteristics except for less horizontal center of mass displacement in the DAA group. At 1 month postoperatively, the DAA group had significantly faster gait speed at self-selected (P=.02) and fastest possible gait (P=.01) and longer step length at self-selected (P=.047) and fastest gait (P=.003) compared to the PA. At 4 months, there were no differences in DAA and PA gait measures. At 1 month postoperatively there were no significant differences in HOOS, but after 4 months HOOS were significantly higher in the DAA group. Conclusion: There were minimal differences between the two approaches in the recovery of gait mechanics with some gait parameters particularly gait speed and step length recovery favoring the DAA at 1 month postsurgery in this nonrandomized study. (c) 2019 Elsevier Inc. All rights reserved.