Does patient-reported perception of pain differ based on surgical approach in total hip arthroplasty?
AIMS
Whether patient-reported pain differs among surgical approaches in total hip arthroplasty (THA) remains unclear. This study's purposes were to determine differences in pain based on surgical approach (direct anterior (DA) vs posterolateral (PL)) and PL approach incision length.


PATIENTS AND METHODS
This was a retrospective investigation from two centres and seven surgeons (three DA, three PL, one both) of primary THAs. PL patients were categorized for incision length (6 cm to 8 cm, 8 cm to 12 cm, 12 cm to 15 cm). All patients had cementless femoral and acetabular fixation, at least one year's follow-up, and well-fixed components. Patients completed a pain-drawing questionnaire identifying the location and intensity of pain on an anatomical diagram. Power analysis indicated 800 patients in each cohort for adequate power to detect a 4% difference in pain (alpha = 0.05, beta = 0.80).


RESULTS
A total of 1848 patients (982 DA, 866 PL) were included. PL patients were younger (59.4 years, sd 12.9 vs 62.7 years, sd 9.7; p < 0.001) and had shorter follow-up (3.3 years, sd 1.3 vs 3.7 years, sd 1.3; p < 0.001). DA patients reported decreased moderate to severe trochanteric (14% vs 21%; p < 0.001) and groin pain (19% vs 24%; p = 0.004) than PL patients. There were no differences in anterior, lateral, or posterior thigh, back, or buttock pain between cohorts (p = 0.05 to 0.7). PL approach incision length did not impact the incidence or severity of pain (p = 0.3 to 0.7).


CONCLUSION
A significant proportion of patients perceive persistent pain following THA regardless of approach. DA patients reported less trochanteric and groin pain versus PL patients. PL incision length did not influence the incidence or severity of patient-reported pain. Cite this article: Bone Joint J 2019;101-B(6 Supple B):31-36.
['Nam|D|D|', 'Nunley|R M|RM|', 'Clohisy|J C|JC|', 'Lombardi|A V|AV|', 'Berend|K R|KR|', 'Barrack|R L|RL|']
D019644:Arthroplasty, Replacement, Hip D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D059352:Musculoskeletal Pain D010147:Pain Measurement D058748:Pain Perception D010149:Pain, Postoperative D012189:Retrospective Studies D057566:Self Report
Pain Total hip arthroplasty Direct anterior approach Outcomes Posterolateral approach