Clinical Orthopaedics and Related Research®

, Volume 469, Issue 6, pp 1574–1581 | Cite as

Direct Anterior Approach for Hip Resurfacing: Surgical Technique and Complications

Symposium: Update on Hard-on-Hard Bearings in Hip Arthroplasty

Abstract

Background

The direct anterior approach (DAA) for hip resurfacing arthroplasty is a technically difficult approach but theoretically reduces the soft tissue trauma to the hip because it does not require muscle detachments from the bone. Furthermore, the patient is in the supine position facilitating fluoroscopy to control component placement. However, the complications associated with the learning curve and functional outcome scores are not well defined in the literature.

Questions/purposes

We therefore asked how our first 57 operations using the anterior approach and special table extension compared with that in the literature with regard to (1) complication rate; (2) functional outcome scores; (3) component placement; and (4) length of stay.

Methods

We retrospectively reviewed 51 patients who underwent 57 hip resurfacing procedures using a DAA. There were 45 men and six women with an average age of 51 years (range, 31–63 years) and a body mass index of 28.7 kg/m2 (range, 19.7–42.0 kg/m2). The minimum followup was 0.3 months (mean, 8.7 months; range, 0.3–24.9 months).

Results

There were three atraumatic (5%) and one posttraumatic (1.8%) femoral neck fractures. Average HOOS scores were equal to or better than averages reported for total hip arthroplasty. Average cup inclination was 36.5° (range, 25°–48°). The average length of stay was 2.11 days (range, 1–4 days).

Conclusions

The surgical approach for anterior hip resurfacing is technically difficult but may have some clinical benefits. Surgeons interested in using the DAA for hip resurfacing should be very familiar with the DAA for total hip arthroplasty and with hip resurfacing.

Level of Evidence

Level IV, retrospective study. See Guidelines for Authors for a complete description of levels of evidence.

References

  1. 1.
    Amstutz HC, Beaule PE, Dorey FJ, Le Duff MJ, Campbell PA, Gruen TA. Metal-on-metal hybrid surface arthroplasty: two to six-year follow-up study. J Bone Joint Surg Am. 2004;86:28–39.PubMedGoogle Scholar
  2. 2.
    Beaule PE, Campbell P, Lu Z, Leunig-Ganz K, Beck M, Leunig M, Ganz R. Vascularity of the arthritic femoral head and hip resurfacing. J Bone Joint Surg Am. 2006;88(Suppl 4):85–96.PubMedCrossRefGoogle Scholar
  3. 3.
    Beaule PE, Dorey FJ, LeDuff M, Gruen T, Amstutz HC. Risk factors affecting outcome of metal-on-metal surface arthroplasty of the hip. Clin Orthop Relat Res. 2004;418:87–93.PubMedCrossRefGoogle Scholar
  4. 4.
    Benoit B, Gofton W, Beaule PE. Hueter anterior approach for hip resurfacing: assessment of the learning curve. Orthop Clin North Am. 2009;40:357–363.PubMedCrossRefGoogle Scholar
  5. 5.
    Bertin KC, Rottinger H. Anterolateral mini-incision hip replacement surgery: a modified Watson-Jones approach. Clin Orthop Relat Res. 2004;429:248–255.PubMedCrossRefGoogle Scholar
  6. 6.
    Gross TP, Liu F. Minimally invasive posterior approach for hip resurfacing arthroplasty. Techniques in Orthopaedics. 2010;25:39–49.CrossRefGoogle Scholar
  7. 7.
    Kapandji IA. The Physiology of the Joints. London: Churchill Livingstone; 1987.Google Scholar
  8. 8.
    Kreuzer SW, Matta J. Single-incision anterior approach for total hip arthroplasty: Smith-Petersen approach. Monogram of the American Academy of Orthopaedic Surgeons. 2007:1–14.Google Scholar
  9. 9.
    Lachiewicz PF. Metal-on-metal hip resurfacing: a skeptic’s view. Clin Orthop Relat Res. 2007;465:86–91.PubMedGoogle Scholar
  10. 10.
    Le Duff MJ, Wisk LE, Amstutz HC. Range of Motion after stemmed total hip arthroplasty and hip resurfacing. Bull NYU Hosp Joint Dis. 2009;67:177–181.Google Scholar
  11. 11.
    Lingard EA, Muthumayandi K, Holland JP. Comparison of patient-reported outcomes between hip resurfacing and total hip replacement. J Bone Joint Surg Br. 2009;91:1550–1554.PubMedCrossRefGoogle Scholar
  12. 12.
    Marker DR, Seyler TM, Jinnah RH, Delanois RE, Ulrich SD, Mont MA. Femoral neck fractures after metal-on-metal total hip resurfacing: a prospective cohort study. J Arthroplasty. 2007;22:66–71.PubMedCrossRefGoogle Scholar
  13. 13.
    Masonis JL, Bourne RB. Surgical approach, abductor function, and total hip arthroplasty dislocation. Clin Orthop Relat Res. 2002;405:46–53.PubMedCrossRefGoogle Scholar
  14. 14.
    Matta JM, Shahrdar C, Ferguson T. Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthop Relat Res. 2005;441:115–124.PubMedCrossRefGoogle Scholar
  15. 15.
    McMinn DJW, Daniel J, Ziaee H, Pradhan C. Posterior surgical approach for hip resurfacing arthroplasty. Techniques in Orthopaedics. 2010;25:73–79.CrossRefGoogle Scholar
  16. 16.
    Meneghini RM, Pagnano MW, Trousdale RT, Hozack WJ. Muscle damage during MIS total hip arthroplasty: Smith-Petersen versus posterior approach. Clin Orthop Relat Res. 2006;453:293–298.PubMedCrossRefGoogle Scholar
  17. 17.
    Mont MA, Marker DR, Smith JM, Ulrich SD, McGrath MS. Resurfacing is comparable to total hip arthroplasty at short-term follow-up. Clin Orthop Relat Res. 2009;467:66–71.PubMedCrossRefGoogle Scholar
  18. 18.
    Mont MA, Seyler TM, Ulrich SD, Beaule PE, Boyd HS, Grecula MJ, Goldberg VM, Kennedy WR, Marker DR, Schmalzried TP, Sparling EA, Vail TP, Amstutz HC. Effect of changing indications and techniques on total hip resurfacing. Clin Orthop Relat Res. 2007;465:63–70.PubMedGoogle Scholar
  19. 19.
    Naal FD, Maffiuletti NA, Munzinger U, Hersche O. Sports after hip resurfacing arthroplasty. Am J Sports Med. 2007;35:705–711.PubMedCrossRefGoogle Scholar
  20. 20.
    Nakata K, Nishikawa M, Yamamoto K, Hirota S, Yoshikawa H. A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series. J Arthroplasty. 2009;24:698–704.PubMedCrossRefGoogle Scholar
  21. 21.
    Nilsdotter AK, Lohmander LS, Klassbo M, Roos EM. Hip disability and osteoarthritis outcome score (HOOS)—validity and responsiveness in total hip replacement. BMC Musculoskelet Disord. 2003;4:10.PubMedCrossRefGoogle Scholar
  22. 22.
    Sandri A, Regis D, Magnan B, Luminari E, Bartolozzi P. Hip resurfacing using the anterolateral Watson-Jones approach in the supine position. Orthopedics. 2009;32:406.PubMedCrossRefGoogle Scholar
  23. 23.
    Shimmin AJ, Back D. Femoral neck fractures following Birmingham hip resurfacing: a national review of 50 cases. J Bone Joint Surg Br. 2005;87:463–464.PubMedCrossRefGoogle Scholar
  24. 24.
    Steffen RT, De Smet KA, Murray DW, Gill HS. A modified posterior approach preserves femoral head oxgenation during hip resurfacing. J Arthroplasty. 2010 Mar 22 [Epub ahead of print].Google Scholar
  25. 25.
    Treacy RB, McBryde CW, Pynsent PB. Birmingham hip resurfacing arthroplasty. A minimum follow-up of five years. J Bone Joint Surg Br. 2005;87:167–170.Google Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  1. 1.Memorial Bone and Joint ClinicHoustonUSA
  2. 2.Indiana School of MedicineIndianapolisUSA

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