Anterior approach in THA improves outcomes: opposes

Abstract

Total hip arthroplasty (THA) can be performed through multiple surgical approaches, including anterior, anterolateral, lateral, transtrochanteric, posterolateral, posterior, and the 2-incision technique. The overwhelming majority of THAs today are performed through a posterolateral approach, which has many advantages: it can be extended without difficulty, it is expeditious, it results in reduced blood loss and little muscle damage, and recovery is rapid. The major disadvantage of the approach is its increased dislocation rate, which has become less of a problem with the advent of larger femoral heads and dual-mobility acetabular components. The anterior approach is another hip approach with advantages and disadvantages. One disadvantage is the need for a special table on which to perform the procedure, which can cost ≥$100,000. Many surgeons also recommend the use of intraoperative fluoroscopy with this approach, which prolongs surgery and adds possible draping contamination during the fluoroscopy. Exposure of the femur may be difficult with this approach, especially in patients with increased body mass index. The operative time also tends to be longer with this approach, as exposure may be more tedious. The published data report significant complications with this procedure.