Current Trends in Clinical Practice for the Direct Anterior Approach Total Hip Arthroplasty

Patel, Nick N.; Shah, Jason A.; Erens, Greg A.

doi:10.1016/j.arth.2019.04.025

Cited by 94 publications

(54 citation statements)

References 35 publications

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“…Usage of minimally invasive, anterior-based approaches for performing primary THA is gaining popularity. A recent survey of the American Association of Hip and Knee Surgeons showed that greater than half of surgeons currently perform the DA approach, with 76.1% of them reporting increased patient market share because of using that approach, and 43.0% of them reporting that over half their patients specifically request it [30]. The AL approach is similar to the DA approach, but enters lateral to the tensor fascia lata rather than medial in the internervous plane.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Periprosthetic Femur Fracture and Influence of Femoral Fixation Using the Mini-Anterolateral Approach in Primary Total Hip Arthroplasty

Herndon

Nowell

Sarpong

et al. 2020

The Journal of Arthroplasty

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Periprosthetic Femur Fracture and Influence of Femoral Fixation Using the Mini-Anterolateral Approach in Primary Total Hip Arthroplasty

Herndon

Nowell

Sarpong

et al. 2020

The Journal of Arthroplasty

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“…A n increasing number of hip surgeons are now shifting their focus to the direct anterior approach (DAA) in China because it is a naturally minimally invasive approach and a robust method for fast-tracking surgery 1 . In our hospital, we have treated over 1000 cases of THA using the DAA since 2015, including over 200 cases of developmental dysplasia of the hip (DDH).…”

Section: Introductionmentioning

confidence: 99%

Direct Anterior Approach in Crowe Type III‐IV Developmental Dysplasia of the Hip: Surgical Technique and 2 years Follow‐up from Southwest China

Liu

Jun

et al. 2020

Orthopaedic Surgery

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Objectives To summarize our pioneering surgical practice and clinical outcome of Crowe type III‐IV developmental dysplasia of the hip (DDH) with a direct anterior approach total hip arthroplasty in a single teaching hospital in Southwest China. Methods Fourteen patients (15 hips) diagnosed with Crowe type III‐IV developmental dysplasia of the hip were involved in this single‐center retrospective study between 2016 and 2018. A comprehensive surgical procedure, including preoperative planning and algorithms for leg length equalization, intraoperative stepwise soft tissue release, bone defect reconstruction, and an innovative subtrochanteric osteotomy, was described. Furthermore, advancements in intraoperative CT guidance, computer navigation, and nerve monitoring were available for specific demands. The short‐term clinical outcome was evaluated at the endpoint of follow‐up by three patient‐reported functional scales (Harris, WOMAC, and SF‐12 scores), and objective data collected at the clinic, including functional recovery (muscle strength of hip flexor and abductor, correction of the pelvic tilt, leg length discrepancy, and limp), radiographic analysis, and complication occurrence. Results The intraoperative variables were carefully recorded. The mean operating times in Crowe type III and IV groups were 115.8 min and 156.2 min, and the median blood loss volumes were 520.5 mL and 810.2 mL, respectively. The general changes in the Harris, SF‐12, and WOMAC scores of the two groups were 46.2, 8.7 and 134.3, respectively, at a mean follow‐up of 25.4 months. Enhanced recovery of hip abductor muscle strength was identified in 85.7% of the population at the third postoperative month. The equalization of leg length and correction of the pelvic tile were observed at the sixth postoperative month, with a 36‐mm decrease in leg length discrepancy. No radiographic evidence of the loosening or migration of the components was observed. A self‐innovated subtrochanteric shortening osteotomy was performed in five patients, and they healed after 6 months. Specific complications included two cases of distal femoral cracks and one case of a periprosthetic fracture needing internal fixation. Two patients received a late iliotibial band release at the 3rd month postoperatively due to progressive genu valgum. No records of infection, dislocation, nerve palsy, bone non‐union, or revision surgery were identified. Discussion The direct anterior approach total hip arthroplasty showed potential advantages, including optimum component positioning, improved hip stability, steerable complication rate, and enhanced functional recovery with Crowe type III‐IV DDH. The short‐term outcome is comparable to that of the traditional posterolateral approach.

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“…In 70% (n = 43) of the hips, this was the first revision, whereas 30% (n = 18) of the hips underwent at least one previous revision (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). In 14 hips, the index procedure was performed in the authors' department, while all others were referrals.…”

Section: Methodsmentioning

confidence: 99%

“…Moreover, due to the supine positioning of DAA patients, intraoperative leg length evaluation and fluoroscopic control of implant positioning may be facilitated. These advantages, among other reasons, may have led to an increasing popularity of the DAA in Europe and the U.S. [6,7]. Recently, an American Association of Hip and Knee Surgeons (AAHKS) survey documented an increasing use of the DAA among respondents, from 12% in 2010 to 40% in 2018 [6].…”

Section: Introductionmentioning

confidence: 99%

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Revision Arthroplasty Through the Direct Anterior Approach Using an Asymmetric Acetabular Component

Prodinger

Lazic

Horas³

et al. 2020

JCM

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Despite increasing numbers of primary hip arthroplasties performed through the direct anterior approach (DAA), there is a lack of literature on DAA revision arthroplasty. The present study was performed in order to evaluate outcomes and revision rates after revision through the DAA using an asymmetric acetabular component with optional intra- and extramedullary fixation. In a retrospective cohort study, we analyzed prospectively collected data of 57 patients (61 hips, 43 female, 18 male) who underwent aseptic acetabular component revision through the DAA with the abovementioned implant system between January 2015 and December 2017. The mean follow-up was 40 months (12–56). Survival rates were estimated using the Kaplan–Meier method. All complications were documented and functional outcomes were assessed pre- and postoperatively. Kaplan–Meier analysis revealed an estimated five-year implant survival of 97% (confidence interval CI 87–99%). The estimated five-year survival with revision for any cause was 93% (CI 83–98%). The overall revision rate was 6.6% (n = 4). Two patients had to undergo revision due to periprosthetic infection (3.3%). In one patient, the acetabular component was revised due to aseptic loosening four months postoperatively. Another patient suffered from postoperative iliopsoas impingement and was treated successfully by arthroscopic iliopsoas tenotomy. Two (3.3%) of the revised hips dislocated postoperatively. The mean Harris Hip Score improved from 35 (2–66) preoperatively to 86 (38–100) postoperatively (p < 0.001). The hip joint’s anatomical center of rotation was restored at a high degree of accuracy. Our findings demonstrate that acetabular revision arthroplasty through the DAA using an asymmetric acetabular component with optional intra- and extramedullary fixation is safe and practicable, resulting in good radiographic and clinical midterm results.

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Current Trends in Clinical Practice for the Direct Anterior Approach Total Hip Arthroplasty

Cited by 94 publications

References 35 publications

Risk Factors for Periprosthetic Femur Fracture and Influence of Femoral Fixation Using the Mini-Anterolateral Approach in Primary Total Hip Arthroplasty

Risk Factors for Periprosthetic Femur Fracture and Influence of Femoral Fixation Using the Mini-Anterolateral Approach in Primary Total Hip Arthroplasty

Direct Anterior Approach in Crowe Type III‐IV Developmental Dysplasia of the Hip: Surgical Technique and 2 years Follow‐up from Southwest China

Revision Arthroplasty Through the Direct Anterior Approach Using an Asymmetric Acetabular Component

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