Assessing early perioperative outcomes of minimally invasive posterior approach versus direct anterior approach total hip arthroplasty: a prospective comparative randomized study on blood and pain management

The choice of the surgical technique while performing total hip arthroplasty (THA) is debated and no consensus exists on which minimally-invasive approach can provide more benefit in achieving enhanced recovery after surgery. The aim of the present study was to compare the early post-operative outcomes of minimally invasive posterolateral approach (Mis-PLA) Vs. direct anterior approach (DAA) in the treatment of primary hip osteoarthritis, with regard to blood loss and postoperative pain. The hypothesis was that mis-PLA, despite being less widely used than DAA, could offer significant advantages over the more popular alternative. Fifty patients treated with THA from 2022 to 2023 at a single Institution were prospectively recruited and randomly assigned to receive either the Mis-PLA or DAA THA. Surgeons and patients were aware of the group assignment, ata analysts were blinded to the allocation. Primary endpoints included intraoperative and postoperative blood loss and the blood transfusion rate. Secondary outcomes included pain assessment using the Visual Analog Scale (VAS), operating time, length of stay (LOS), and perioperative complications. The DAA group was associated with significantly higher intraoperative blood loss (266.0 ± 202.4 mL) compared to the Mis-PLA group (157.2 ± 50.9 mL; p < 0.05). No significant differences in postoperative blood loss were observed between the two groups (DAA: 238.0 ± 104.4 mL; Mis-PLA: 195.8 ± 135.9 mL) ( p = 0.280). Patients in the DAA group had a higher transfusion rate (12%) than those in the Mis-PLA group (3%), although the difference did not reach statistical significance ( p = 0.610). No statistically significant differences were reported in VAS scores between the two groups on the first or third postoperative day ( p = 0.483, and p = 0.236, respectively), nor for LOS ( p = 0.667). The operating time was significantly longer in the DAA group (85.6 ± 12.5) compared to the Mis-PLA group (61.6 ± 13.7; p < 0.0001). No major complications were reported in either group. Compared to the DAA, the Mis-PLA could be a suitable option for surgeons aiming to minimize intraoperative blood loss and reduce operating time during THA. No statistically significant differences were reported between the two groupsconcerning postoperative blood loss, perioperative pain, length of hospital stay, or complication rates.