Abstract
The direct anterior approach (DAA) for total hip arthroplasty (THA) has become an extremely familiar concept over the last 8 to 10 years. There has been growing pressure to utilise this approach driven by the lay press, implant manufacturers looking for an edge, as well as from surgeons looking for a marketing advantage. This media and industry presence could leave many surgeons feeling that we delay adoption of the DAA at the risk of losing patients or at minimum must have a good explanation as to why we have chosen not to perform “that surgery where you come in from the front.”
The atmosphere of perceived superiority of DAA has occurred in spite of numerous publications identifying unique risks and complications, including steeply increased complication rates in the “learning curve”, while lacking data identifying its promised advantages when compared to the “modern posterior approach” to THA. It persists despite a recent prospective comparative study that failed to identify any clinical advantages for the anterior THA versus a “mini-posterior” THA and other evidence from state joint registries that has shown the dislocation rate of the DAA is not significantly different from posterior hip approaches.
It essential to understand the considerations that differentiate traditional posterior THA from “modern” posterior-based THA. The advancements made in pain management, rapid rehabilitation and patient education all contribute substantially to the enhanced recovery of the “modern THA”. Furthermore, the extensile exposures such as the Moore, Gibson or Kocher Langenbeck approaches are no longer the type of “posterior” approach that is applied to routine primary THA. Many iterations of posterior-based approaches are now performed with a far more limited and soft tissue preserving approach. It is the purpose of this brief presentation to describe the clinical results of 1000 consecutive hips performed using one such “modern THA,” which has allowed us to obtain early recovery benefits, including the outpatient setting. This is achieved without the additional risk profile assumed with the DAA and with an easily extensile approach. Through these examples we can show that not only is “the back” back, but that for those who were paying attention, it is clear it never really went away.
