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Review
. 2025 Aug 28.
doi: 10.1007/s00132-025-04707-7. Online ahead of print.

Approach-specific complication management in direct anterior approach total hip arthroplasty

Salome Hagelstein  1 , Lennart Marvin Schröder  1 , Florian Pachmann  1 , Dominic Simon  1 , Boris Michael Holzapfel  2 , Gautier Beckers  1
Affiliations
Review

Approach-specific complication management in direct anterior approach total hip arthroplasty

Salome Hagelstein et al. Orthopadie (Heidelb). .

Abstract
in English, German

The direct anterior approach (DAA) has become increasingly established in primary total hip arthroplasty due to its muscle-sparing access, low dislocation rates and fast rehabilitation. At the same time, it requires a nuanced approach to complication management. This article addresses common DAA-specific challenges and outlines strategies for treatment, involving distal and proximal surgical approach extensions and strategies for fracture management through the same approach. With appropriate techniques even complex revisions of the femur and acetabulum can be performed via the DAA and its extensions. For experienced surgeons, this approach thus provides a safe and effective option, even in revision settings.

Der direkte vordere Zugang (DAA) hat sich bei der primären Hüftendoprothetik aufgrund des muskelschonenden Zugangs, niedriger Luxationsraten und schneller Rehabilitation zunehmend auch in Deutschland etabliert. Gleichzeitig erfordert er ein differenziertes Komplikationsmanagement. Dieser Beitrag beleuchtet typische DAA-spezifische Komplikationen und stellt Strategien zur Therapie, inklusive operativer proximaler und distaler Erweiterungsmöglichkeiten über denselben Zugang dar. Auch komplexe Revisionen an Femur und Azetabulum können so bei entsprechender Technik über den DAA erfolgen. Für den geübten Operateur bietet der Zugang somit auch im Revisionsfall sichere und effektive Therapieoptionen.

Keywords: Direct anterior approach; Hip joint; Periprosthetic fracture; Revision arthroplasty; Surgical approach extension.

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Conflict of interest statement

Declarations. Conflict of interest: S. Hagelstein, L.M. Schröder, F. Pachmann, D. Simon, B.M. Holzapfel and G. Beckers declare that they have no competing interests. For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.

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