Abstract
There has been great enthusiasm over the last few years for the mini-anterior, or, the Direct Anterior (DA) approach. As the title of this session suggests there is a perception that there are features of this approach that result in an unusually rapid recovery with “early” return to a high level of function. There have also been claims of improved implant placement and limb length restoration. This is presumably a result of the use of intra-operative imaging. When originally described, it was stated that the DA permitted THA “without cutting any tendons.” The implication was that the alleged unique recovery was due to this particular feature.
Over the last decade I have used a trans-gluteal, direct posterior (DP) approach. Incision into the ITB is not required and quadratus femoris is preserved. The conjoined tendon, occasionally the piriformis, and rarely the obturator externus are released. Over the last 5 years I have used intra-operative digital radiography to guide the procedure.
A review of published DA results indicates at least clinical equivalence with the DP. Recent publications describing DA technique acknowledge that it is required, in most cases, to release conjoined tendon, and possibly piriformis. Personal communication with DA practitioners suggests even more “posterior release” is required. I will illustrate that the DP is a very close anatomic equivalent of the DA. It is therefore the handling of critical anatomic structures along with the use of image guidance that optimise outcome in THA and not mini-anterior or DA exclusively.
