Does the Direct Anterior Approach in THA Offer Faster Rehabilitation and Comparable Safety to the Posterior Approach?

Rodríguez, José A.; Deshmukh, Ajit; Rathod, Parthiv; Greiz, Michelle; Deshmane, Prashant; Hepinstall, Matthew S.; Ranawat, Amar S.

doi:10.1007/s11999-013-3231-0

Cited by 195 publications

(187 citation statements)

References 34 publications

Supporting

Mentioning

162

Contrasting

Unclassified

Order By: Relevance

“…The direct anterior approach to THA has been gaining popularity as a result of the proposed minimally invasive nature of this approach, faster and earlier recovery [1,8,22], and the reported lower incidence of dislocation after this technique [14,25]. Our study shows improvement in the variability of acetabular cup position after use of direct anterior approach THAs with fluoroscopy by a surgeon experienced in posterior approach THAs, however, there is a learning curve associated with the use of fluoroscopy to achieve improved accuracy in acetabular component positioning.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Does Fluoroscopy With Anterior Hip Arthoplasty Decrease Acetabular Cup Variability Compared With a Nonguided Posterior Approach?

Rathod

Bhalla

Deshmukh

et al. 2014

Clinical Orthopaedics &Amp; Related Research

Self Cite

132

110

View full text Add to dashboard Cite

Background The direct anterior approach for THA offers some advantages, but is associated with a significant learning curve. Some of the technical difficulties can be addressed by the use of intraoperative fluoroscopy which may improve the accuracy of acetabular component placement. Questions/purposes The purposes of this study were to determine if (1) there is decreased variability of acetabular cup inclination and anteversion with the direct anterior approach using fluoroscopic guidance as compared with the posterior approach THA without radiographic guidance; (2) if there is a learning curve associated with achieving accuracy with the direct anterior approach THA. We also wanted (3) to assess the frequency of complications including dislocation with the anterior approach, which initially had a learning curve, and the posterior approach. Methods This retrospective, comparative study of 825 THAs (372 posterior THAs without fluoroscopic guidance and 453 direct anterior THAs, performed by one surgeon, focused on a radiographic analysis to determine cup inclination and anteversion on standardized pelvic radiographs using specialized software. The first 100 direct anterior THAs performed while transitioning from the posterior approach to the direct anterior approach were included in the learning curve group. During this learning curve period, the direct anterior approach was used for all patients except those with conversion of previously fixed intertrochanteric or femoral neck fractures to THAs, gluteus medius tears, and obese patients with an immobile abdominal pannus (100 of 127 THAs). Variability of the acetabular component was compared among the posterior group, learning curve group, and direct anterior group. Results Variances for cup inclination and anteversion were significantly lower in the direct anterior group (19 and 16 respectively, p \ 0.01) as compared with the posterior group (50 and 79 respectively).Target inclination and anteversion were achieved better in the direct anterior group (98% and 97% respectively) as compared with the posterior group (86% and 77% respectively) (p \ 0.01, OR for inclination = 9.1, 95% CI, 3.5 to 23.4; OR for anteversion = 8, 95% CI, 4 to 16). In the learning curve group, target anteversion achieved (91% of cases) was marginally lower than that of the direct anterior group (p = 0.03; OR = 2.9, 95% CI, 1.1 to 7.3) and target inclination (95%) was similar (p = 0.13). There was one posterior dislocation in the posterior group, two anterior dislocations in the learning curve group, and none in the direct anterior group.

show abstract

Section: Discussionmentioning

confidence: 99%

“…There is some clinical data to support that it offers early recovery as compared with the lateral, anterolateral, and posterior approaches with no longterm clinical differences [1,8,21,22]. However, it has been shown to have a significant learning curve [3,26].…”

Section: Introductionmentioning

confidence: 99%

Does Fluoroscopy With Anterior Hip Arthoplasty Decrease Acetabular Cup Variability Compared With a Nonguided Posterior Approach?

Rathod

Bhalla

Deshmukh

et al. 2014

Clinical Orthopaedics &Amp; Related Research

Self Cite

132

110

View full text Add to dashboard Cite

show abstract

“…The issue of groin pain remains a real one. Although our study did not demonstrate a statistical difference, it may have been underpowered to do so [7]. Focus on assuring anterior coverage of the implant by bone has diminished the issue at our center.…”

mentioning

confidence: 63%

“…Our recently published level 2 study comparing DAA with the posterior approach demonstrated objective and consistent benefits in early mobility, but most findings were equalized by 2 weeks post op, and by 6 weeks post op there was no measurable differences between the groups [7]. In addition, we have presented data on early recovery of muscle strength, showing DAA patients may have early flexion weakness, and posterior approach patients may have external rotation weakness, most of which resolves by 6 months [9].…”

mentioning

confidence: 73%

“…The dislocation rate with DAA is certainly not zero. Sariali reported a 1.5% dislocation rate, while Keggi, Masonis, and Matta report dislocation rates of 2.5%, 0.3%, and 0.6%, respectively [4][5][6][7]. Each of these reports represents the evolution of technique at the respective centers, including optimization of implant position and soft tissue tension, and the use of flouroscopic guidance in 2 of the 4 reports.…”

mentioning

confidence: 99%

See 1 more Smart Citation