Over the past 15 years Anterior Approach (AA) THA has shown a dramatic increase in adoption by surgeons (over 30%) and choice by patients with a corresponding decrease in the percentage of hips performed with traditional posterior and lateral approaches.

I began AA in 1996 in order to solve the classic problems of potential dislocation associated with posterior approach and potential abductor weakness associated with the lateral (Harding) approach. Surgeon education on AA began in 2013 and has accelerated since.

AA is usually performed with the aid of an orthopaedic table which facilitates exposure though many cases are also performed on a standard operating table. Intraoperative image intensification has provided real-time feedback and accuracy for cup position leg length and offset and is facilitated by the supine position and a radiolucent orthopaedic table, however, AA can be performed without it.

Earlier functional recovery with decreased post-operative pain is the best documented benefit of AA as well as decreased dislocation rate.

My own point of view is to take advantage of a switch to AA to improve more than your surgical approach. Improve also hip biomechanics, cup position, ease of surgery, bone preparation, and soft tissue handling. A proven and repeatable technique and use of available technologies will facilitate this.

For learning any new technique the main principle to follow is: learn the technique thoroughly from start to finish and adopt it as taught, without attempting to modify it until you are very familiar with it. Orthopaedic table enhanced anterior approach THA (ATHA) is at this point a well-established teachable and repeatable technique though its safety and efficacy depends on adherence to details. These technical details have evolved to become part of the technique since I first taught it at a course in 2003. The technical details and innovations have utilised the invaluable input from high volume expert surgeons as well as from less experienced surgeons taking on the challenges of learning.

Considering anterior approach (AA), three technical aspects can be a “mental block” for the uninitiated surgeon: 1) supine position, 2) the orthopaedic table, 3) checking cup position, leg length and offset with the image intensifier/C-arm. Keep in mind that though you may have been initially trained and experienced with lateral position, a flat table and no x-ray checks, these three technical aspects greatly facilitate Anterior Approach and enhance its repeatability, safety, accuracy and overall “ease of use”.

Anterior approach technical instruction is available at a number of venues and the preceding is consistent with the surgeon developed technique taught at courses. Visiting a surgeon who is expert in AA can also provide an effective supplemental educational experience.