Surgical Approaches for Total Hip Arthroplasty

Abstract

Total hip arthroplasty (THA) has become one of the most reliable and patient-requested surgical interventions in all medicine. The procedure can be performed using a variety of surgical approaches, but the posterior approach, direct lateral approach, and direct anterior approach are by far the most common across the globe. This article highlights the history and technique for each of these common approaches. A review of outcomes and complications for each approach are also provided. Each approach has its own unique advantages and disadvantages, but all can be safely and successful utilized for THA. Strong, convincing, high-quality studies comparing the different approaches are lacking at this time. Surgeons are therefore recommended to choose whichever approach they are most comfortable and experienced using. Though not described here, THA can also be done using the anterolateral approach (also known as the Watson Jones approach) as well as the two-incision approach. In addition, recently, some surgeons are utilizing the so-called direct superior approach for THA. While these approaches are far less commonly utilized, they are recognized as viable alternatives to traditional approaches.

Evaluation of Direct Anterior Approach for Revision Total Hip Arthroplasty: A Systematic Review

“…The DAA for THA has grown in popularity owing to its usage of inter-muscular and inter-nervous plane and the preservation of both the external rotators and the hip abductors 7 22) . Literature shows strong results and advantages, in relation to the dislocation rate and heterotopic ossification, compared with other approaches in both mid to long term 23 24 25 26 27 28) .…”

“…The approach to the hip joint depends upon the component to be revised as anterolateral, direct lateral, or posterolateral approaches are used for acetabular component revision. In general, surgeons avoid using the anterior approach as it has been suggested that bone grafting and approaching the posterior column is difficult through this approach which forms a major step for cup revisions 7) . In addition, because it is a recent it has been sparingly described and limited experience has led to feigning disinterest among arthroplasty surgeons for revision.…”

Posterior Versus Anterior Approach to Total Hip Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Whereas the posterior is the most traditional and popular approach worldwide, 1 ), ( 2 the anterior approach has gained prominence during the second half of the 20th century with the contributions of Smith-Petersen. ( 3 ), ( 4 The number of studies comparing different approaches and techniques for THA has increased in recent years, with a recent study highlighting the controversies over the evidence for clinical outcomes and economic factors favoring the anterior approach. ( 5 However, high-quality evidence evaluating the potential superiority of one method over another is limited.…”

Outcome and EBRA migration analysis of a reconstruction cage in acetabular revision arthroplasty: a clinical and radiological study

“…Two senior consultant surgeons performed over 90% of all the surgeries mentioned in this study. Three different approaches were used: in 58 cases a direct anterior approach [15,16], in five cases a lateral transgluteal approach [17] and once a dorsal approach [18,19]. The surgical approach was chosen in way of a) initial approach, b) the bone defect, which has to be addressed in revision surgery and c) the reachability through the chosen approach.…”