Abstract
Introduction
The anterior approach to primary total hip arthroplasty is an unfamiliar approach to most surgeons that is considered to be minimally invasive based on the premise that there is less soft tissue damage and quicker post-operative recovery time. We present our experience of using the anterior approach exclusively by a single surgeon at multiple surgical centers for a period of 3.5 years.
Method
709 consecutive patients undergoing primary hip arthroplasties from 8/2007 to 12/2010 through a direct anterior approach were performed by single surgeon with extensive training in the approach. The procedure was performed with the patient supine on a fracture table (Trumph arch table extension) through an anterior approach as described by Dr. Joel Matta through a Smith-Peterson interval. Intra-operative data and complications were collected prospectively and to avoid missing any complications, electronic medical records (Alteer) were retrospectively reviewed.
Results
The demographic characteristics of patients are listed in Table 1 and intra-operative data collected presented in Table 2. The overall major complication rate was 2.81% (19/709). Overall revision rate due to any cause was 1.83% (13/709). Wound related complications were 6.67% which included any type of drainage noted during post op clinic visits, wound dehiscence, stitch abscesses, or superficial infections requiring irrigation and debridement.
Discussion
The anterior approach through a modified Smith-Petersen approach provides preservation of the major hip muscles to facilitate recovery. However, the lack of familiarity with the approach has prevented widespread adoption of the method. Our overall major complication rate was in the lower end of the range of published complication rates (range, 1.36%-15.79%). Although the high incidence of wound complications is of concern, it can be explained by the location of the incision being in an area where large skin folds or moist skin make healing difficult. We have since implemented a preoperative protocol to sterilize the area near the inguinal area and included silver impregnated dressing to help decrease our wound related complications.
