What question did this study set out to answer?

This study aims to compare recovery metrics including step counts, pain, and sleep quality between two surgical approaches for hip replacement.

May 16, 2026

No Objective Difference in Early Recovery of Direct Anterior and Posterior Approach Total Hip Arthroplasty With Daily Remote Monitoring

Key Points

This study aims to compare recovery metrics including step counts, pain, and sleep quality between two surgical approaches for hip replacement.
Single-institution, prospective cohort study of 94 THAs (45 DAA, 49 PA) using the same implants.
Participants included those with unilateral OA and BMI <40 using a wrist-based wearable device.
Step counts, pain levels, and patient-reported outcomes assessed over 12 weeks using standardized questionnaires.
No significant difference in step count change between DAA and PA at any time point (P>0.05).
No differences in VAS, HOOS Jr, or FJS pain scores across the studied time points (P>0.05).
No significant disparities in overall PSQI scores or recorded sleep hours at any time point (P>0.05).

Abstract

Background Direct anterior approach (DAA) has become increasingly utilized for total hip arthroplasty (THA). Proponents cite faster recovery and less pain. However, most studies comparing approaches utilize different implants. Additionally, little is known about postoperative sleep quality between approaches. The purpose of this study was to compare step counts, pain, patient-reported outcomes (PROMs), and sleep quality within first 12-weeks of DAA and posterior approach (PA) THA utilizing the same implants. Methods This was a single-institution, prospective, cohort study of 94 THAs (45 direct-anterior approach (DAA), 49 posterior approach (PA)) utilizing the same triple-tapered stem and hemispherical shell. Demographics were similar, but DAA had lower BMI (27 vs 30, p0.05). There were no differences in VAS, HOOS Jr, or FJS at any timepoint (p>0.05). There were no differences between DAA and PA in overall PSQI score, PSQI sleep quantity score, or monitor recorded hours of sleep at any time point (P>0.05). Conclusion This prospective study utilizing daily remote monitoring and the same implants did not identify a difference in THA by DAA or PA with regards to functional recovery, pain, or sleep quality in the early postoperative period.

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