The direct anterior approach to the hip: a useful tool in experienced hands or just another approach?

Abstract

The direct anterior approach (DAA) to the hip was initially described in the nineteenth century and has been used sporadically for total hip arthroplasty (THA). However, recent increased interest in tissue-sparing and small incision arthroplasty has given rise to a sharp increase in the utilization of the DAA. Although some previous studies claimed that this approach results in less muscle damage and pain as well as rapid recovery, a paucity in the literature exists to conclusively support these claims. While the DAA may be comparable to other THA approaches, no evidence to date shows improved long-term outcomes for patients compared to other surgical approaches for THA. However, the advent of new surgical instruments and tables designed specifically for use with the DAA has made the approach more feasible for surgeons. In addition, the capacity to utilize fluoroscopy intraoperatively for component positioning is a valuable asset to the approach and can be of particular benefit for surgeons during their learning curve. An understanding of its limitations and challenges is vital for the safe employment of this technique. This review summarizes the pearls and pitfalls of the DAA for THA in order to improve the understanding of this surgical technique for hip replacement surgeons.

Exploring the clinical value of direct anterior approach THA for short-term hip function improvement: A single-center retrospective analysis of short-term outcomes

“…Furthermore, this approach effectively circumvents injury to the external rotator muscles inherent in the PA, thereby safeguarding therapeutic efficacy and enhancing operative safety. [11][12][13][14] In clinical practices, the daily life and movement of patients who need hip replacement are greatly restricted, and their self-care ability is relatively poor. Hip replacement can effectively improve the patients' hip joint limitation, enhance their self-care ability, and help the patients to establish the confidence in treatment, as well as to improve their quality of life.…”

“…Furthermore, this approach effectively circumvents injury to the external rotator muscles inherent in the PA, thereby safeguarding therapeutic efficacy and enhancing operative safety. [11–14]…”

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

“…The commonly reported surgical technique of the DAA has been applied [ 18 , 19 ]. In detail, patients were placed in supine position and surgery was performed on a standard operation table.…”

Clinical outcomes of modified direct lateral approach of Hardinge for total hip arthroplasty

“…Realyvasquez et al evaluated direct anterior approach by reviewing the literature and concluded that the published literature remains inconclusive about the superiority of these approach. Besides the complications associated with the approach and mentioned above, there is contraindication in using it for the patients with higher body mass index 22 . Hardinge approach has no contraindication regarding the obese patients due to versatility and extensibility and we didn't recorded risk of complications (longer operative time, increased operative bleeding, intraoperative fracture or nerve injury) related to the surgery time for these patients.…”