Abstract
INTRODUCTION:
The popularity of the direct anterior approach (DAA) for total hip arthroplasty (THA) is increasing as this approach causes less soft tissue damage and no muscular detachments and significantly shorter postoperative recovery time. Despite the promising early results the complication rate in the DAA cases has been concerning such as 9% rate in 247 DAA cases reported by Woolen et. al [1]. As DAA has not conventionally being used by surgeons these complications are expected to be reduced when the surgeons are more experienced. Therefore to better understand the issues that cause the postop complications in DAA we have conducted the present study.
OBJECTIVES:
The objective of the current study is to investigate the postop complications in individuals with arthritic hips treated by DAA THA over a period of 3.5 years by a one surgeon.
METHODS:
The procedure was performed with the patient supine on a fracture table via DAA [2]. Briefly, the approach consisted of making a 8–10 cm incision 2 cm distal and lateral to the anterior superior iliac spine to a point several centimeters anterior to the greater trochanter. The dissection advanced to visualize the anterior capsule at the interval between the tensor and the sartorius and rectus femoris muscles. The neck was osteotomized at a pre-determined level through pre-operative templating. The acetabular component was prepared through sequential reaming followed by proper exposure for preparation of the femur, with sequential increasing size broaches used until a tight proximal fit was obtained with rotational stability. Hip stability with trial components was assessed by externally rotating the hip using the fracture table along with intra-operative radiographs. All post-operative clinic notes were reviewed retrospectively for any type of complication at any follow-up visit following primary THA. Intraoperative data and complications were collected prospectively.
RESULTS:
709 consecutive patients underwent primary hip arthroplasty from 8/2007 to 12/2010 via DDA performed by a single surgeon. 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.
CONCLUSION:
The lack of familiarity with the DAA in THA has prevented widespread adoption of the method. Our overall major complication rate was in the lower end of the range that is published complication rates (range of 1.36% >15.79%). The location of the incision is in an area where large skin folds and the moist skin make healing difficult. This may result in higher infections. Therefore a preoperative protocol to sterilize the sections near the inguinal area has been implemented to reduce wound related complications. Future studies should be conducted to evaluate the learning curve in different surgeons who perform THA using DAA.
