Abstract
In the early days of total hip arthroplasty, the discussion of surgical approaches centered on issues related to obtaining optimum exposure for accurate insertion and fixation of implants and appropriate restoration of hip kinematics. More recently, attention has been directed to those aspects of exposure that appear to be associated with rapid recovery, shorter lengths of stay, less pain and minimal gait disturbance. The role of less invasive (“MIS”) exposures in achieving these outcomes has been sharply and extensively debated. Currently, the Direct Anterior Approach is being used by an increasing number of surgeons to address these outcomes. The purpose of this presentation is to discuss the relationship of total hip surgical approaches to peri-operative morbidity, rate of functional recovery, length of hospital stay and ultimate lower extremity function.
Many factors affect the quality and rate of recovery from THA surgery. These include: 1) patient characteristics; 2) implant type; 3) surgical exposure and technique; and 4) peri-operative management. Numerous reports suggest that patient selection and effective peri-operative management have the greatest impact on the rate of recovery. The quality of the arthroplasty outcome is related to the accuracy with which the procedure is performed, regardless of the surgical approach used. Available evidence strongly suggests that the quality of the surgical technique used to perform a THA is a much more important determinant of outcome than the surgical approach used.
