Single-surgeon Level I RCT comparing direct anterior approach (DAA) vs posterolateral approach (PA) for primary THA in 87 patients. Evaluated functional recovery, pain, radiographic alignment, and complications through 12 months. Primary endpoint was ability to walk unlimited distances AND climb stairs normally.
A patient scheduled for THA asks which approach gets them home faster and back on stairs sooner. This Level I RCT gives you a precise answer: DAA triples the rate of combined stair-climbing and unlimited walking at 6 weeks, more than doubles day-of-surgery walking distance, and cuts length of stay by nearly a full day.
For patients where early independence matters most — avoiding skilled nursing, returning to work, maintaining home function. DAA is the data-supported choice. The consent conversation must include the tradeoffs: 24 extra minutes of OR time, twice the blood loss, and a steeper early learning curve penalty.
Beyond 6 months, approach selection becomes irrelevant. Set this expectation at the preoperative visit so patients calibrate recovery goals correctly from the start.
The alignment data belong on your boards flashcard: fluoroscopy-guided DAA achieved neutral stem alignment in 98% vs 74%, and the series' only dislocation revision was placed at 59°/58°. A concrete illustration of the Lewinnek safe zone's clinical consequences.
Single-surgeon Level I RCT comparing direct anterior approach (DAA) vs posterolateral approach (PA) for primary THA in 87 patients. Evaluated functional recovery, pain, radiographic alignment, and complications through 12 months. Primary endpoint was ability to walk unlimited distances AND climb stairs normally.
A patient scheduled for THA asks which approach gets them home faster and back on stairs sooner. This Level I RCT gives you a precise answer: DAA triples the rate of combined stair-climbing and unlimited walking at 6 weeks, more than doubles day-of-surgery walking distance, and cuts length of stay by nearly a full day.
For patients where early independence matters most — avoiding skilled nursing, returning to work, maintaining home function. DAA is the data-supported choice. The consent conversation must include the tradeoffs: 24 extra minutes of OR time, twice the blood loss, and a steeper early learning curve penalty.
Beyond 6 months, approach selection becomes irrelevant. Set this expectation at the preoperative visit so patients calibrate recovery goals correctly from the start.
The alignment data belong on your boards flashcard: fluoroscopy-guided DAA achieved neutral stem alignment in 98% vs 74%, and the series' only dislocation revision was placed at 59°/58°. A concrete illustration of the Lewinnek safe zone's clinical consequences.