Abstract
Purpose
Described for the first time in the 1950s, the direct anterior approach to the hip has been gaining in popularity over the last decade following the trend of minimally invasive surgery. This paper provides an overview of the approach and its indications and various uses and focuses on its utility in the revision setting. A detailed overview of the technique including tips and tricks as well as an explanation of common errors are included.
Method
Graphic and clinical study of the approach, indications and feasibility.
Results
The reported benefits of the direct anterior technique include enhanced post-operative recovery and respect for all the innervation and vascularization territories. It has been shown to be safe and effective in revision settings, to decrease the occurrence of heterotopic ossification, to enhance the accuracy of acetabular cup positioning, and to improve post-operative rehabilitation while having comparable outcomes in terms of loosening or component failure. Additionally, thromboembolic events have been shown to be decreased compared to other approaches. The most common reported complications in the revision setting is intra-operative fracture. The decision of a surgeon to transition to this approach, however, comes with a learning curve and potentially detrimental complications if done improperly.
Discussion
In addition to its appeal in the primary setting, the approach could possibly be a solution to decrease the morbidity associated with revision surgery through its use of a fresh tissue plane not previously traumatized with the primary approach.
Similar content being viewed by others
References
Prokopetz JJ, Losina E, Bliss RL, Wright J, Baron JA, Katz JN (2012) Risk factors for revision of primary total hip arthroplasty: a systematic review. BMC Musculoskelet Disord 13:251
Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ (2009) The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am 91(1):128–133
Bozic KJ, Katz P, Cisternas M, Ono L, Ries MD, Showstack J (2005) Hospital resource utilization for primary and revision total hip arthroplasty. J Bone Joint Surg Am 87(3):570–576
Fehring TK, Odum SM, Fehring K, Springer BD, Griffin WL, Dennos AC (2010) Mortality following revision joint arthroplasty: is age a factor? Orthopedics 33(10):715
Judet J, Judet R (1950) The use of an artificial femoral head for arthroplasty of the hip joint. J Bone Joint Surg (Br) 32-B(2):166–173
Matta JM, Shahrdar C, Ferguson T (2005) Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthop Relat Res 441:115–124
Nakata K, Nishikawa M, Yamamoto K, Hirota S, Yoshikawa H (2009) A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series. J Arthroplasty 24(5):698–704
Restrepo C, Parvizi J, Pour AE, Hozack WJ (2010) Prospective randomized study of two surgical approaches for total hip arthroplasty. J Arthroplasty 25(5):671–679, e1
Martin CT, Pugely AJ, Gao Y, Clark CR (2013) A comparison of hospital length of stay and short-term morbidity between the anterior and the posterior approaches to total hip arthroplasty. J Arthroplasty 28(5):849–854
Parvizi J, Rasouli MR, Jaberi M, Chevrollier G, Vizzi S, Sharkey PF, Hozack WJ (2013) Does the surgical approach in one stage bilateral total hip arthroplasty affect blood loss? Int Orthop 37(12):2357–2362
De Anta-Diaz B, Serralta-Gomis J, Lizaur-Utrilla A, Benavidez E, Lopez-Prats FA (2016) No differences between direct anterior and lateral approach for primary total hip arthroplasty related to muscle damage or functional outcome. Int Orthop
Newman EA, Holst DC, Bracey DN, Russell GB, Lang JE (2015) Incidence of heterotopic ossification in direct anterior vs posterior approach to total hip arthroplasty: a retrospective radiographic review. Int Orthop
Kobayashi H, Homma Y, Baba T, Ochi H, Matsumoto M, Yuasa T, Kaneko K (2015) Surgeons changing the approach for total hip arthroplasty from posterior to direct anterior with fluoroscopy should consider potential excessive cup anteversion and flexion implantation of the stem in their early experience. Int Orthop
Unger AC, Schulz AP, Paech A, Jurgens C, Renken FG (2013) Modified direct anterior approach in minimally invasive hip hemiarthroplasty in a geriatric population: a feasibility study and description of the technique. Arch Orthop Trauma Surg 133(11):1509–1516
Mast NH, Laude F (2011) Revision total hip arthroplasty performed through the Hueter interval. J Bone Joint Surg Am 93(Suppl 2):143–148
Kennon R, Keggi J, Zatorski LE, Keggi KJ (2004) Anterior approach for total hip arthroplasty: beyond the minimally invasive technique. J Bone Joint Surg Am 86-A(Suppl 2):91–97
Scemama C, Lestrat V, Combourieu B, Judet T (2015) Anterior approach for total hip arthroplasty conversion of hip fusion. Int Orthop
Seng BE, Berend KR, Ajluni AF, Lombardi AV Jr (2009) Anterior-supine minimally invasive total hip arthroplasty: defining the learning curve. Orthop Clin North Am 40(3):343–350
Jewett BA, Collis DK (2011) High complication rate with anterior total hip arthroplasties on a fracture table. Clin Orthop Relat Res 469(2):503–507
Homma Y, Baba T, Sano K, Ochi H, Matsumoto M, Kobayashi H, Yuasa T, Maruyama Y, Kaneko K (2015) Lateral femoral cutaneous nerve injury with the direct anterior approach for total hip arthroplasty. Int Orthop
Pavlanski R (1971) Modification of the Zahradnicek-Leveuf procedure in the case of subdislocating coxa valga with anteversion. Rev Chir Orthop Reparatrice Appar Mot 57(Suppl 1):185–186
Heller KD, Prescher A, Zilkens KW, Forst R (1997) Anatomic study of femoral vein occlusion during simulated hip arthroplasty. Surg Radiol Anat 19(3):133–137
Binns M, Pho R (1990) Femoral vein occlusion during hip arthroplasty. Clin Orthop Relat Res (255); 168–172
Alecci V, Valente M, Crucil M, Minerva M, Pellegrino CM, Sabbadini DD (2011) Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: perioperative findings. J Orthop Traumatol 12(3):123–129
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Smark, York and Judet have nothing to disclosed. Mauffrey is a Consultant for Stryker; Educational consultant Depuy-Synthes; Abbot Medical; Editor – Springer
Additional information
Illustrations for figures by Philip York MD
Rights and permissions
About this article
Cite this article
York, P.J., Smarck, C.T., Judet, T. et al. Total hip arthroplasty via the anterior approach: tips and tricks for primary and revision surgery. International Orthopaedics (SICOT) 40, 2041–2048 (2016). https://doi.org/10.1007/s00264-016-3125-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-016-3125-3