Anterior muscle sparing approach for total hip arthroplasty

Abstract

The purpose of this review is to examine the validity of positive claims regarding the direct anterior approach (DAA) with a fracture table for total hip arthroplasty. Recent literature regarding the DAA was searched and specific claims investigated including improved early outcomes, speed of recovery, component placement, dislocation rates, and complication rates. Recent literature is positive regarding the effects of total hip arthroplasty with the anterior approach. While the data is not definitive at present, patients receiving the anterior approach for total hip arthroplasty tend to recover more quickly and have improved early outcomes. Component placement with the anterior approach is more often in the "safe zone" than with other approaches. Dislocation rates tend to be less than 1% with the anterior approach. Complication rates vary widely in the published literature. A possible explanation is that the variance is due to surgeon and institutional experience with the anterior approach procedure. Concerns remain regarding the "learning curve" for both surgeons and institutions. In conclusion, it is not a matter of should this approach be used, but how should it be implemented.

Adverse effects associated with the direct anterior approach for total hip arthroplasty: a Bayesian meta-analysis

“…Woolson et al [43] reports a reduced visibility due to smaller exposure during minimal invasive surgery as a cause of less accurate component positioning. However, Moskal et al [10] stated that the supine positioning facilitates the use of fluoroscopy or navigation to accurately assess component alignment and intra-operative leg length discrepancy. Nakata et al found significantly more cups placed in the safe zone with DAA as compared to the mini-posterior approach [44].…”

“…Peripheral neurological complication rates reported in the literature vary extensively from 0.0 to 14.81 % [10,25,42]. In the majority of cases comprising our analysis (Fig.…”

“…Recent review articles describe improved early outcomes and faster recovery as the main advantages of this muscle-sparing technique [10,46,47].…”

“…It was first described by Judet in 1947 [3], yet only became recently popularized in 2005 following publications by Matta et al [4,5]. Advocates of this musclesparing approach claim many benefits, including shorter rehabilitation times, quicker return to normal function, less surgical trauma, minimal soft tissue dissection, better component placement, and the shorter skin incision required [5][6][7][8][9][10]. The benefits of the DAA are mostly associated with its use of muscle preservation rather than muscle splitting, the latter of which occurs with more-traditional approaches.…”

“…However, the DAA has also been associated with a higher rate of complications [2,[11][12][13][14]. Reported complication rates vary widely in the published literature [10] and meta-analyses on associated outcomes are scarce.…”