JOA - 2026-06-01 - Journal Article; Comparative Study
Superior Transverse Atraumatic Reconstruction Total Hip Arthroplasty Achieves Similar Satisfaction and Minimal Clinically Important Differences When Compared to the Direct Anterior Approach: A Propensity Score Matched Study With Two-Year Outcomes.
Jared Chua HY, Jiawei C, Yeo SJ, Pang HN, Keng-Jin Tay D, Lincoln Liow MH
Topics
Key Takeaway
Technology-assisted DAA THA produced statistically higher 2-year Oxford Hip Scores and SF-36 subscores than manually performed STAR THA, but MCID attainment, patient satisfaction, and complication rates were equivalent in 132 propensity-matched pairs.
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Summary
This propensity score-matched retrospective study compared 2-year PROMs, satisfaction, and complications between technology-assisted DAA THA and manually performed STAR THA (a posterolateral variant) in patients >60 years at a single high-volume center. DAA demonstrated statistically higher scores across Oxford Hip Score, WOMAC stiffness and physical function, and multiple SF-36 domains at 2 years. However, no between-group differences existed in MCID attainment, patient satisfaction, or expectation fulfillment, and complication rates were equivalent.
Key Limitation
The technology confound—DAA performed with fluoroscopic or robotic assistance versus manually performed STAR—makes it impossible to attribute outcome differences to surgical approach alone rather than to adjunctive technology.
Original Abstract
BACKGROUND
Numerous studies comparing the direct anterior approach (DAA) and postero-lateral approach in total hip arthroplasty (THA) have been inconclusive, mostly demonstrating earlier recovery with DAA, with no differences in outcomes by one year. However, there are limited studies comparing the DAA with the superior transverse atraumatic reconstruction (STAR) THA, which is a type of postero-lateral approach. This study aimed to compare the 2-year follow-up patient-reported outcome measures, satisfaction, and complication rates between DAA and STAR THA.
METHODS
A retrospective analysis of all primary THAs performed (January 2018 to December 2022) at a high-volume tertiary hospital was conducted. The study included patients >60 year at the time of THA with minimum 2-year outcomes of Oxford Hip Score, Western Ontario and McMaster University Arthritic Index, Short-Form 36 Health Survey subscale and summative (physical component score/mental component scores), patient satisfaction, and expectation fulfillment scores. The DAA THA was performed with either fluoroscopic or robotic assistance, whereas the STAR THA was performed manually. Logistic regressions were performed to estimate propensity scores, followed by greedy matching in a 1:1 ratio to establish the DAA and STAR groups. Parametric and nonparametric statistical tests were used to compare postoperative scores and the proportion attaining a minimal clinically important difference (MCID). A total of 132 DAA THA were successfully matched with 132 STAR THA.
RESULTS
The DAA group demonstrated significantly higher scores in 2-year postoperative Oxford Hip Score (P = 0.0140), Western Ontario and McMaster University Arthritic Index stiffness (P = 0.0455), physical function (P = 0.0125), Short-Form 36 Health Survey physical function (P = 0.00537), general health (P = 0.0495), social function (P = 0.0266), physical component score (P = 0.0478), and mental component score (P = 0.0482). There was no difference in MCID attainment, patient satisfaction, or expectation fulfillment scores noted.
CONCLUSIONS
While technology-assisted DAA THA demonstrated better functional outcomes at two years, its clinical relevance may be limited, as manually performed STAR THA also attained MCID thresholds and yielded high patient satisfaction rates without additional complications. This suggests that slightly lower functional scores do not compromise overall THA success.