Total hip arthroplasty via the anterior approach: tips and tricks for primary and revision surgery
- 1.2k Downloads
Described for the first time in the 1950s, the direct anterior approach to the hip has been gaining in popularity over the last decade following the trend of minimally invasive surgery. This paper provides an overview of the approach and its indications and various uses and focuses on its utility in the revision setting. A detailed overview of the technique including tips and tricks as well as an explanation of common errors are included.
Graphic and clinical study of the approach, indications and feasibility.
The reported benefits of the direct anterior technique include enhanced post-operative recovery and respect for all the innervation and vascularization territories. It has been shown to be safe and effective in revision settings, to decrease the occurrence of heterotopic ossification, to enhance the accuracy of acetabular cup positioning, and to improve post-operative rehabilitation while having comparable outcomes in terms of loosening or component failure. Additionally, thromboembolic events have been shown to be decreased compared to other approaches. The most common reported complications in the revision setting is intra-operative fracture. The decision of a surgeon to transition to this approach, however, comes with a learning curve and potentially detrimental complications if done improperly.
In addition to its appeal in the primary setting, the approach could possibly be a solution to decrease the morbidity associated with revision surgery through its use of a fresh tissue plane not previously traumatized with the primary approach.
KeywordsAnterior hip replacement Surgical technique Direct anterior hip THA
Compliance with ethical standards
Smark, York and Judet have nothing to disclosed. Mauffrey is a Consultant for Stryker; Educational consultant Depuy-Synthes; Abbot Medical; Editor – Springer
- 5.Judet J, Judet R (1950) The use of an artificial femoral head for arthroplasty of the hip joint. J Bone Joint Surg (Br) 32-B(2):166–173Google Scholar
- 11.De Anta-Diaz B, Serralta-Gomis J, Lizaur-Utrilla A, Benavidez E, Lopez-Prats FA (2016) No differences between direct anterior and lateral approach for primary total hip arthroplasty related to muscle damage or functional outcome. Int OrthopGoogle Scholar
- 12.Newman EA, Holst DC, Bracey DN, Russell GB, Lang JE (2015) Incidence of heterotopic ossification in direct anterior vs posterior approach to total hip arthroplasty: a retrospective radiographic review. Int OrthopGoogle Scholar
- 13.Kobayashi H, Homma Y, Baba T, Ochi H, Matsumoto M, Yuasa T, Kaneko K (2015) Surgeons changing the approach for total hip arthroplasty from posterior to direct anterior with fluoroscopy should consider potential excessive cup anteversion and flexion implantation of the stem in their early experience. Int OrthopGoogle Scholar
- 17.Scemama C, Lestrat V, Combourieu B, Judet T (2015) Anterior approach for total hip arthroplasty conversion of hip fusion. Int OrthopGoogle Scholar
- 20.Homma Y, Baba T, Sano K, Ochi H, Matsumoto M, Kobayashi H, Yuasa T, Maruyama Y, Kaneko K (2015) Lateral femoral cutaneous nerve injury with the direct anterior approach for total hip arthroplasty. Int OrthopGoogle Scholar
- 23.Binns M, Pho R (1990) Femoral vein occlusion during hip arthroplasty. Clin Orthop Relat Res (255); 168–172Google Scholar