A research report and John Charnley Award winner published in Clinical Orthopaedics and Related Research investigates the ongoing controversy between surgical approach for total hip arthroplasty. The report discussed studies showing that the direct anterior approach (DAA) leads to less muscle damage than the miniposterior approach (MPA) but indicated that there is little high-quality evidence indicating whether this accelerates recovery, or whether this potentially technically more demanding approach is associated with component malposition or more complications. 

The study findings suggest that both the DAA and MPA approaches provide excellent early recovery with a low risk of complications. Patients undergoing the DAA had a slightly faster recovery, as measured by milestones of function and quantified by activity monitor data, but no substantive differences were evident at 2 months. Because the DAA is the less studied approach, longer term (> 1 year) complications may yet accrue, will be important to quantify, and may offset early benefits.