Direct Anterior Approach for Total Hip Arthroplasty

Abstract

The direct anterior approach (DAA) to the hip was initially described in the 19th century and has been used sporadically for total hip arthroplasty (THA). In the past decade, enthusiasm for the approach has been renewed because of increased demand for minimally invasive techniques. New surgical instruments and tables designed specifically for use with the DAA for THA have made the approach more accessible to surgeons. Some authors claim that this approach results in less muscle damage and pain as well as rapid recovery, although limited data exist to support these claims. The DAA may be comparable to other THA approaches, but there is no evidence to date that shows improved long-term outcomes for patients. The steep learning curve and complications unique to this approach (fractures and nerve damage) have been well described. However, the incidence of these complications decreases with greater surgeon experience. A question of keen interest to hip surgeons and patients is whether the DAA results in improved early outcomes and long-term results comparable to those of other approaches for THA.

Financial impact of total hip arthroplasty: a comparison of anterior versus posterior surgical approaches

“…Traditionally, one of the most common surgical approaches to total hip arthroplasty (THA) has been the posterior approach (PA), in which the hip joint is accessed by splitting the gluteus maximus muscle [1], [2]. However, in recent years, there has been increasing focus on minimally invasive surgical approaches to THA because of the potential to improve perioperative outcomes and hasten patient recovery [2], [3], [4].…”

“…However, in recent years, there has been increasing focus on minimally invasive surgical approaches to THA because of the potential to improve perioperative outcomes and hasten patient recovery [2], [3], [4]. The anterior, or Smith-Petersen, surgical approach has been shown to improve functional recovery in the early postoperative period [5], [6], [7], [8], [9], [10].…”

“…The anterior, or Smith-Petersen, surgical approach has been shown to improve functional recovery in the early postoperative period [5], [6], [7], [8], [9], [10]. Although the AA and PA have comparable long-term success rates, discrepancy is reported in the early postoperative period [2], [4], [6], [11]. The anterior approach (AA) uses the intermuscular and internervous intervals between the sartorius and the tensor fascia lata muscles.…”

Capsular Ligament Function After Total Hip Arthroplasty

“…Our medial wall approach further removed bias and confounding factors from these data. It avoided using a specific incision or repair technique, for which there are many in routine clinical use [1][2][3][4][5][6][7][8][9][10][11][12] , and it allowed for a repeated-measures study design that reduced the effects of interspecimen and procedural variability. The resulting baseline data on the effects of head size and neck length can therefore be interpreted with respect to any surgical approach.…”

“…any surgical approaches for total hip arthroplasty (THA) aim to maximize capsule preservation [1][2][3][4][5][6][7][8][9][10] and/or repair capsule incisions [1][2][3][4][5][6][7][8][9] , while others excise the capsule to improve exposure, as it is considered of little consequence 11,12 . Capsule preservation and repair can help to lower dislocation rates 6,7,10,[13][14][15][16][17][18] , and may also maintain the defenses of the native hip against hypermobility, impingement, subluxation, and edge-loading [19][20][21][22] .…”