Abstract
This chapter explores the benefits of a standard incision for the approach to anterior total hip arthroplasty and identifies keys in the exposure for achieving adequate hemostasis, avoiding complications, and maximizing surgical efficiency. This will also highlight current evidence and anatomic considerations throughout the approach and detail some pearls and pitfalls for its use in current practice.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Bibliography
Rachbauer F, Kain MS, Leunig M. The history of the anterior approach to the hip. Orthop Clin North Am. 2009;40(3):311–20.
Light TR, Keggi KJ. Anterior approach to hip arthroplasty. Clin Orthop Relat Res. 1980;152:255–60.
Miller LE, Gondusky JS, Bhattacharyya S, Kamath AF, Boettner F, Wright J. Does surgical approach affect outcomes in total hip arthroplasty through 90 days of follow-up? A systematic review with meta-analysis. J Arthroplast. 2018;33(4):1296–302.
Cheng TE, Wallis JA, Taylor NF, Holden CT, Marks P, Smith CL, et al. A prospective randomized clinical trial in total hip arthroplasty-comparing early results between the direct anterior approach and the posterior approach. J Arthroplast. 2017;32(3):883–90.
Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplast. 2013;28(9):1634–8.
Hozack WJ, Heller S. Direct anterior hip exposure for total hip arthroplasty. JBJS Essent Surg Tech. 2015;5(4):e22.
Kyriakopoulos G, Poultsides L, Christofilopoulos P. Total hip arthroplasty through an anterior approach: the pros and cons. EFORT Open Rev. 2018;3(11):574–83.
Higgins BT, Barlow DR, Heagerty NE, Lin TJ. Anterior vs. posterior approach for total hip arthroplasty, a systematic review and meta-analysis. J Arthroplast. 2015;30(3):419–34.
Nogler MM, Thaler MR. The direct anterior approach for hip revision: accessing the entire femoral diaphysis without endangering the nerve supply. J Arthroplast. 2017;32(2):510–4.
Ghijselings SG, Driesen R, Simon JP, Corten K. Distal extension of the direct anterior approach to the hip: a cadaveric feasibility study. J Arthroplast. 2017;32(1):300–3.
Ghijselings SGM, Driesen R, Simon JP, Corten K. Distal extension of the anterior approach to the hip using the femoral Interbundle technique: surgical technique and case series. J Arthroplast. 2017;32(7):2186–90.
Thaler M, Dammerer D, Krismer M, Ban M, Lechner R, Nogler M. Extension of the direct anterior approach for the treatment of Periprosthetic femoral fractures. J Arthroplast. 2019;34(10):2449–53.
Jahng KH, Bas MA, Rodriguez JA, Cooper HJ. Risk factors for wound complications after direct anterior approach hip arthroplasty. J Arthroplast. 2016;31(11):2583–7.
Herndon CL, Drummond N, Sarpong NO, Cooper HJ, Shah RP, Geller JA. Direct anterior versus mini-anterolateral approach for primary total hip arthroplasty: early postoperative outcomes and complications. Arthroplast Today. 2020;6(2):257–61.
Poehling-Monaghan KL, Kamath AF, Taunton MJ, Pagnano MW. Direct anterior versus miniposterior THA with the same advanced perioperative protocols: surprising early clinical results. Clin Orthop Relat Res. 2015;473(2):623–31.
Taunton MJ, Trousdale RT, Sierra RJ, Kaufman K, Pagnano MW. John Charnley award: randomized clinical trial of direct anterior and Miniposterior approach THA: which provides better functional recovery? Clin Orthop Relat Res. 2018;476(2):216–29.
Purcell RL, Parks NL, Gargiulo JM, Hamilton WG. Severely obese patients have a higher risk of infection after direct anterior approach total hip arthroplasty. J Arthroplast. 2016;31(9 Suppl):162–5.
Purcell RL, Parks NL, Cody JP, Hamilton WG. Comparison of wound complications and deep infections with direct anterior and posterior approaches in obese hip arthroplasty patients. J Arthroplast. 2018;33(1):220–3.
Tissot C, Vautrin M, Luyet A, Borens O. Are there more wound complications or infections with direct anterior approach total hip arthroplasty? Hip Int. 2018;28(6):591–8.
Lanting BA, Hartley KC, Raffoul AJ, Burkhart TA, Sommerville L, Martin GR, et al. Bikini versus traditional incision direct anterior approach: is there any difference in soft tissue damage? Hip Int. 2017;27(4):397–400.
Manrique J, Paskey T, Tarabichi M, Restrepo C, Foltz C, Hozack WJ. Total hip arthroplasty through the direct anterior approach using a bikini incision can be safely performed in obese patients. J Arthroplast. 2019;34(8):1723–30.
Matta JM, Shahrdar C, Ferguson T. Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthop Relat Res. 2005;441:115–24.
Flierl MA, Stahel PF, Hak DJ, Morgan SJ, Smith WR. Traction table-related complications in orthopaedic surgery. J Am Acad Orthop Surg. 2010;18(11):668–75.
Lall AC, Saadat AA, Battaglia MR, Maldonado DR, Perets I, Domb BG. Perineal pressure during hip arthroscopy is reduced by use of Trendelenburg: a prospective study with randomized order of positioning. Clin Orthop Relat Res. 2019;477(8):1851–7.
Patton RS, Runner RP, Lyons RJ, Bradbury TL. Clinical outcomes of patients with lateral femoral cutaneous nerve injury after direct anterior total hip arthroplasty. J Arthroplast. 2018;33(9):2919–26 e1.
Goulding K, Beaule PE, Kim PR, Fazekas A. Incidence of lateral femoral cutaneous nerve neuropraxia after anterior approach hip arthroplasty. Clin Orthop Relat Res. 2010;468(9):2397–404.
Bhargava T, Goytia RN, Jones LC, Hungerford MW. Lateral femoral cutaneous nerve impairment after direct anterior approach for total hip arthroplasty. Orthopedics. 2010;33(7):472.
Zlotorowicz M, Czubak-Wrzosek M, Wrzosek P, Czubak J. The origin of the medial femoral circumflex artery, lateral femoral circumflex artery and obturator artery. Surg Radiol Anat. 2018;40(5):515–20.
Lakhiani C, Lee MR, Saint-Cyr M. Vascular anatomy of the anterolateral thigh flap: a systematic review. Plast Reconstr Surg. 2012;130(6):1254–68.
Ward WT, Fleisch ID, Ganz R. Anatomy of the iliocapsularis muscle. Relevance to surgery of the hip. Clin Orthop Relat Res. 2000;374:278–85.
Fox AJ, Bedi A, Wanivenhaus@ F, Sculco TP, Fox JS. Femoral neuropathy following total hip arthroplasty: review and management guidelines. Acta Orthop Belg. 2012;78(2):145–51.
Farrell CM, Springer BD, Haidukewych GJ, Morrey BF. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg Am. 2005;87(12):2619–25.
Patton RS, Runner RP, Lazarus D, Bradbury TL. Femoral neuropathy following direct anterior total hip arthroplasty: an anatomic review and case series(dagger). J Surg Case Rep. 2018;2018(9):rjy171.
Shubert D, Madoff S, Milillo R, Nandi S. Neurovascular structure proximity to acetabular retractors in total hip arthroplasty. J Arthroplast. 2015;30(1):145–8.
Sullivan CW, Banerjee S, Desai K, Smith M, Roberts JT. Safe zones for anterior acetabular retractor placement in direct anterior total hip arthroplasty: a cadaveric study. J Am Acad Orthop Surg. 2019;27(21):e969–e76.
Yoshino K, Nakamura J, Hagiwara S, Suzuki T, Kawasaki Y, Ohtori S. Anatomical implications regarding femoral nerve palsy during a direct anterior approach to total hip arthroplasty: a cadaveric study. J Bone Joint Surg Am. 2020;102(2):137–42.
Mortazavi SMJ, Kazemi M, Noaparast M. Femoral artery intimal injury following total hip arthroplasty through the direct anterior approach: a rare but potential complication. Arthroplast Today. 2019;5(3):288–91.
Ometti M, Brambilla L, Gatti R, Tettamanti A, La Cava T, Pironti P, et al. Capsulectomy vs capsulotomy in total hip arthroplasty. Clinical outcomes and proprioception evaluation: study protocol for a randomized, controlled, double blinded trial. J Orthop. 2019;16(6):526–33.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Runner, R.P., Barnett, S.L. (2022). Why I Favor a Standard Incision and Keys to Exposure for the Anterior Approach. In: Matta, J.M., Sah, A.P. (eds) Anterior Hip Replacement. Springer, Cham. https://doi.org/10.1007/978-3-030-91896-5_8
Download citation
DOI: https://doi.org/10.1007/978-3-030-91896-5_8
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-91895-8
Online ISBN: 978-3-030-91896-5
eBook Packages: MedicineMedicine (R0)