The Direct Anterior Approach (DAA) as a Standard Approach for Total Hip Arthroplasty (THA) in Coxa Profunda and Protrusio Acetabuli? A Radiographic Analysis of 188 Cases

Abstract

Introduction: The direct anterior approach (DAA) represents a well-recognized soft tissue sparing technique for primary total hip arthroplasty (THA). The feasibility and suitability of the DAA in cases of complex acetabular deformities, namely coxa profunda (CP) and protrusio acetabuli (PA), remain to be determined. Methods: A total of 188 cases of CP (100 cases) and PA (88 cases) hips undergoing primary THA via the DAA were retrospectively analyzed. Surgical and radiographic parameters were evaluated and potential complications were assessed. Finally, successful implantation was defined if surgical and radiographic parameters were well within established values of non-complex primary THA. Results: In 159 hips, the medial border of the acetabular component was transferred laterally to the ilioischial line, corresponding to a fully treated acetabular protrusion. In 23 (12.23%) cases, mild, and in 5 (2.66%) cases, moderate residual acetabular protrusion remained after THA. Postoperatively, 11.40% (PA group) and 9.00% (CP group) had a leg length discrepancy (LLD) greater than 10 mm. The mean operative time was significantly less than 60 min. A linear relationship between the BMI and operative time was observed, with an additional 0.9 min of operative time per BMI unit. Overall, complications were rare and did not differ between the two groups. Conclusion: The results of this study suggest that the DAA is a suitable approach for primary THA in patients with coxa profunda and acetabular protrusion if performed by experienced surgeons familiar with the DAA. Obese patients with acetabular protrusion may pose a significant limitation to the DAA and caution should be advised in cases of obesity.

Endoscopic Arthroplasty via Mini‐open Direct Anterior Approach Improves Postoperative Complications and Acetabular Components of Total Hip Arthroplasty in Obese Patients

“…Heinz et al . 33 also showed that obese patients with acetabular protrusion may pose a significant limitation to the DAA. In this study, we found that 98.2% cup anteversion and 95.4% cup inclination in the Endo‐DAA group were inside the “safe zone.” While the rates of the cup anteversion outside of the “safe zone” were 24.1% and 17.7% in the Bikini DAA group and the conventional DAA group with significant differences compared to the Endo‐DAA group.…”

Does Body Mass Index (BMI) Affect the Reconstruction of Biomechanical Parameters in Patients Undergoing Total Hip Replacement (THR) through the Direct Anterior Approach (DAA)?

“…Correlating the radiographic findings with clinical data would have added additional strength to this study. So far, very limited studies have investigated the influence of BMI on cup positioning during DAA-THA [43,55]. Al-Amiry et al were the first to examine the association of BMI with leg-length discrepancy and femoral offset restoration [32].…”