Total hip arthroplasty via the anterior approach: tips and tricks for primary and revision surgery

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.

Keywords: Anterior hip replacement; Direct anterior hip; Surgical technique; THA.