OTSR - 2026-07-10 - Journal Article
Return to daily life activities after total hip arthroplasty by direct anterior approach: A digitally monitored Monocentric Study with a focus on early postoperative pain.
Fauré F, Girardot G, Guicherd W, Bonin N
Topics
Key Takeaway
83% of DAA THA patients achieved full ADL recovery within 3 months, with male sex (OR 1.93) but not early postoperative pain independently predicting recovery.
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Summary
This single-center retrospective study evaluated ADL recovery trajectories in 435 patients undergoing primary DAA THA using continuous digital monitoring of VAS pain scores and PROMs. 361/435 patients (83%) achieved full ADL recovery by 3 months; male sex was the only independent predictor (OR 1.93, 95% CI 1.07–3.48). VAS pain scores were identical between groups from day 1–45 but diverged at day 90, suggesting late pain differences are a consequence rather than a driver of recovery.
Key Limitation
The absence of a comparator approach group makes it impossible to determine whether the 83% ADL recovery rate at 3 months is attributable to the DAA or reflects the expected recovery curve for primary THA regardless of approach.
Original Abstract
INTRODUCTION
Total hip arthroplasty (THA) is a widely performed procedure for managing end-stage hip osteoarthritis. Among the available approaches, the direct anterior approach (DAA) has gained popularity due to its potential for rapid functional recovery and early return to daily life activities. Digital monitoring provides new opportunities to objectively track recovery trajectories and evaluate the role of early postoperative pain in this process, which remains insufficiently characterized.
OBJECTIVE
The aim of this study was to evaluate recovery of daily life activities after THA performed through the DAA, using continuous digital monitoring to collect pain scores and patient-reported outcomes. Particular attention was given to the influence of early postoperative pain on the pace of functional recovery.
METHODS
This is a retrospective, single-center study including 435 patients monitored via a dedicated digital application, who underwent primary THA via the DAA between January 2022 and December 2023. Patients were categorized into two groups based on their recovery of ADL within 3 months post-surgery. ADL group included independent walking, normal stair climbing, regained autonomy, driving, shopping, and returning to light sports activities. The primary outcome was the return to ADL, and secondary outcomes included VAS pain scores repeatedly measured throughout the recovery process and patient-reported outcome measures (PROMs). Statistical analyses were performed to identify significant factors influencing recovery.
RESULTS
Among the 435 patients included, 361 (83%) achieved full recovery of ADL within 3 months. Male gender was independently associated with a higher likelihood of ADL recovery (OR = 1.93, 95% CI [1.07-3.48], p = 0.03). PROMs were significantly better in the ADL group, including higher Harris Hip Score (92.7 ± 7.61 vs. 87.53 ± 12.08, p = 0.008) and Hip Disability and Osteoarthritis Outcome Score (86.42 ± 23.28 vs. 83.78 ± 20.4, p = 0.017) at 3 months. VAS pain scores did not differ from day 1 to day 45 but were significantly lower in the ADL group at postoperative day 90 (0.497 ± 1.05 vs. 0.824 ± 1.29, p = 0.012).
CONCLUSION
In this retrospective cohort, 83% of patients achieved full ADL within 3 months after THA performed through a direct anterior approach. Gender was associated with ADL recovery, whereas early postoperative pain was not. These findings describe recovery patterns within this cohort.
LEVEL OF EVIDENCE
IV; Retrospective study.