Direct Anterior Approach is Associated with Superior Postoperative Sexual Function Compared with Anterolateral Approach in Men Undergoing Total Hip Arthroplasty: A Prospective Cohort Study

Abstract

Abstract Objectives Total hip arthroplasty (THA) is increasingly performed in younger men, many of whom regard sexual function as an important component of postoperative quality of life. Regular sexual activity contributes to overall well-being. Hip osteoarthritis (OA) impairs sexual activity in up to 70% of patients, and THA may restore it and improve sexual quality of life. Although the direct anterior approach (DAA) has been associated with faster recovery, its influence on patient-centred outcomes such as sexual health remains insufficiently studied. To our knowledge, erectile function after THA has not been compared between surgical approaches. Methods In this prospective multicentre cohort study, 87 sexually active men aged 18–65 years underwent primary THA via either DAA ( n = 49) or the anterolateral approach (ALA; n = 38). Outcomes were assessed preoperatively and 6 months postoperatively using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC; pain, stiffness, function), the World Health Organization Quality of Life-BREF (WHOQOL-BREF; physical and psychological domains), and the International Index of Erectile Function-5 (IIEF-5). Data were analysed using two-way mixed-design ANOVAs. Results Both groups demonstrated significant postoperative improvements in pain, stiffness, physical function, and quality of life. Compared with the ALA group, the DAA group had lower postoperative pain and greater reduction in stiffness (both p < .001). Erectile function improved significantly in the DAA group ( p < .001), whereas no significant change was observed in the ALA group. Conversely, the ALA group showed greater improvements in physical well-being ( p = .049) and psychological well-being ( p < .001). Conclusions Both approaches improved function and quality of life after THA. DAA was associated with greater reductions in pain and stiffness and may confer an additional benefit in erectile function, whereas ALA was associated with greater perceived gains in overall well-being. Larger studies with more comparable cohorts are warranted.