Early Outcome Comparison Between the Direct Anterior Approach and the Mini-Incision Posterior Approach for Primary Total Hip Arthroplasty: 150 Consecutive Cases

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

“…In 17 [7,11,12,14,[23][24][25][26][27][28][29][30][31][32][33][34][35] of the 38 studies, the authors noted that outcome data were derived from the first patient series for which the DAA was used. Therefore, a learning curve may have been present.…”

Greater trochanter chip fractures in the direct anterior approach for total hip arthroplasty

“…Owing to the worldwide increase in the popularity of the DAA in THA [11,12], the relatively higher rate of complications during the learning curve for the DAA should be further addressed [13]. In this study, the size of the greater trochanter was identified as a risk factor for chip fracture of the greater trochanter in patients undergoing THA using the DAA by a beginner.…”

“…If proximal femur elevation is achieved with these external manipulations, chip fracture of the greater trochanter could be minimized. However, other surgeons use standard surgical tables, which have other merits [8,13,20]. With the use of standard tables, a bone hook and/or retractor must be used for the proximal femur elevation, putting the tip of the greater trochanter at risk of chip fracture.…”

The influence of surgical approach on outcomes of total hip arthroplasty

“…As previously mentioned, the posterior approach is associated with a risk of dislocation but this finding has not been compared specifically to the direct lateral approach 6 . Pain assessments, although a subjective measure, have also indicated that patients who undergo THA through a lateral approach experience more discomfort than those undergoing a DAA 43,44 , narcotic analgesic use was also reported to be increased in patients who underwent PA compared with the DAA 45 . There does not appear to be a significant difference between the PA and direct lateral approaches peri-operatively, however pain levels during recovery for both are slightly elevated compared to the DAA which is likely due to the relatively muscle-sparing approach of this latter technique.…”