Total Hip Arthroplasty Via the Anterior Approach: Tips and Tricks for Primary and Revision Surgery

Overview

Journal Int Orthop

Specialty Orthopedics

Date 2016 Feb 12

PMID 26865188

Citations 15

Authors

Philip J York

Charles T Smarck

Thierry Judet

Cyril Mauffrey

Affiliations

Soon will be listed here.

Abstract

Purpose: Described for the first time in the 1950s, the direct anterior approach to the hip has been gaining in popularity over the last decade following the trend of minimally invasive surgery. This paper provides an overview of the approach and its indications and various uses and focuses on its utility in the revision setting. A detailed overview of the technique including tips and tricks as well as an explanation of common errors are included.

Method: Graphic and clinical study of the approach, indications and feasibility.

Results: The reported benefits of the direct anterior technique include enhanced post-operative recovery and respect for all the innervation and vascularization territories. It has been shown to be safe and effective in revision settings, to decrease the occurrence of heterotopic ossification, to enhance the accuracy of acetabular cup positioning, and to improve post-operative rehabilitation while having comparable outcomes in terms of loosening or component failure. Additionally, thromboembolic events have been shown to be decreased compared to other approaches. The most common reported complications in the revision setting is intra-operative fracture. The decision of a surgeon to transition to this approach, however, comes with a learning curve and potentially detrimental complications if done improperly.

Discussion: In addition to its appeal in the primary setting, the approach could possibly be a solution to decrease the morbidity associated with revision surgery through its use of a fresh tissue plane not previously traumatized with the primary approach.

Citing Articles

"Intra-operative assessment of leg length discrepancy with anterior approach total hip replacement: a comparison between standard table, position table with and without intra-operative radiographs".

Viglietta E, Fenucci S, Iorio R, Parisien A, Grammatopoulos G, Kim P Int Orthop. 2025; .

PMID: 39951054 DOI: 10.1007/s00264-025-06411-9.

Fused hip conversion to total hip arthroplasty with the direct anterior approach: surgical technique on a regular surgical table under fluoroscopic guidance.

Mimendia I, Barro V, Sierra M, Aliaga-Martinez A, Guerra-Farfan E, Hernandez A Int Orthop. 2024; 48(5):1165-1170.

PMID: 38438578 DOI: 10.1007/s00264-024-06131-6.

Does robot-assisted surgery reduce leg length discrepancy in total hip replacement? Robot-assisted posterior approach versus direct anterior approach and manual posterior approach: a propensity score-matching study.

Ma M, Song P, Zhang S, Kong X, Chai W J Orthop Surg Res. 2023; 18(1):445.

PMID: 37344859 PMC: 10286345. DOI: 10.1186/s13018-023-03864-9.

The direct anterior approach for simultaneous bilateral total hip arthroplasty: a short-term efficacy analysis.

Chen C, Yin Y, Juncai L, Chen G Arthroplasty. 2022; 2(1):21.

PMID: 35236445 PMC: 8796357. DOI: 10.1186/s42836-020-00040-w.

Clinical evaluation of direct anterior approach total hip arthroplasty for severe developmental dysplasia of the hip.

Liu Z, Bell C, Ong A, Zhang J, Li J, Zhang Y Sci Rep. 2021; 11(1):8105.

PMID: 33854151 PMC: 8046760. DOI: 10.1038/s41598-021-87543-x.

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