Abstract
The direct anterior approach to total hip arthroplasty (THA) is growing in popularity. This growth is fueled by interest from surgeons and patients alike, both of whom are in search of improved outcomes in THA.
While the benefits of the approach are likely less pronounced than some marketing claims made, delivering a surgical recovery that has less pain and faster function is of significant value to today's patient. Published data has demonstrated subtle improvement in pain and function when compared with both the lateral and posterior approaches. Usually these clinical results are equivalent by 2 or 3 months post-operative. This can lead to accelerated recovery, a shorter length of stay, and a more cost-effective result. Some surgeons have utilised this approach as they implement outpatient THA as well.
Another added benefit is that a supine patient positioning allows for easy implementation of intra-operative fluoroscopy, which has been shown to reduce outliers in component positioning. Improved component positioning has the potential to reduce dislocation rates, lower bearing wear, and improve longevity. While image guided implant positioning can be used with any approach or patient position, it is efficient, affordable, and available to implement with the anterior approach. Using intra-operative imaging requires learning how to use and interpret the image, because incorrect utilization of fluoroscopy can be as harmful as it can be helpful.
Surgeons who are contemplating adapting the approach in practice must be aware of the potential pitfalls and learning curve, as studies have demonstrated increased operative time, blood loss, and peri-operative complications in the early cases. However, with appropriate training, patient selection, and implementation, the approach can be safely used in all THA patients.
