Direct Anterior Approach

The Direct Anterior Approach is one of the minimally invasive techniques used in total hip replacement surgery. Continuing orthopaedic experience suggests that this technique may be associated with reduced muscle damage and pain, as well as faster post-operative recovery[1].

 

Traditional hip replacement techniques involve operating from the side (lateral) or the back (posterior) of the hip, which requires a significant disturbance of the joint and connecting tissues and an incision approximately 8-12 inches long.

In comparison, the Direct Anterior Approach requires an incision that may be 3-4 inches in length and located at the front of the hip[2]. In this position, the surgeon does not need to detach any of the muscles or tendons[2]. 

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The table below illustrates the key potential benefits between traditional

replacement and the Direct Anterior Approach.

Under a doctor's supervision, patient may be assisted to walk later on the day of surgery

Do not bend hip more than a right angle

May potentially avoid some restrictions associated with traditional hip replacement

Do not turn feet excessively inward or outward

Use a pillow between your legs when sleeping

General Surgical Complications

As with any surgery, hip replacement carries certain risks. Some complications may be more common with the Direct Anterior Approach, including bone and soft tissue complications. You should talk with your doctor to better understand the risks and complications before making the decision to undergo total hip replacement. Below are some complications that may arise in DAA total hip replacement procedures.

  • Soft tissue injuries

  • Blood loss

  • General hip surgery complications which may include inadvertent leg lengthening, dislocation, and medical complications such as deep vein thrombosis (DVT) and infection.

Decreased hospital stay and quicker rehabilitation

Potential for smaller incision and reduced muscle disruption may allow patients a shorter recovery time and less scarring

Due to the minimally invasive nature, patients may have a decreased risk of hip dislocation after surgery

May allow for a more natural return to normal function and activity compared to the posterior lateral approach

References

 

  1. Post, Zachary D., MD, Orozco, Fabio, MD, Diaz-Ledezma, Claudio, MD, Hozack, William J., MD, Ong, Alvin, MD 2014© Journal of the American Academy of Orthopaedic Surgeons.

  2. Wenz, J., Gurkan, I. Jibodh, S., “Mini-Incision Total Hip Arthroplasty: A Comparative Assessment of Perioperative Outcomes,” Orthopedics Magazine, 2002.

  3. AAOS website, www.orthoinfo.org/topic.cfm?topic=A00377#Other%20Precautions, accessed Nov 2014.

  4. www.anteriorhip.org, Kreuzer, S.

  5. J Moskal, MD. “Anterior Approach in THA Improves Outcomes: Affirms”. Orthopedics 34.9 (2011): e456-e458.

  6. W Barret, MD, S Turner. “Prospective Randomized Study of Anterior vs. Postero-Lateral Approach for Total Hip Arthroplasty”. American Academy of Orthopaedic Surgeons Annual Meeting 2012. Presentation number 655.

  7. E Sariali, MD, P Leonard, MD, P Mamoudy, MD. “Dislocation After Total Hip Arthroplasty Using Heuter Anterior Approach”. The Journal of Arthroplasty 23.2 (2008): 269.

  8. Keggi, Kristaps I., “Total Hip Arthroplasty Through a Minimally Invasive Anterior Surgical Approach,” JBJS, Vol. 85-A. 2003.

  9. Baerga-Varela, L., Malanga, G.A., “Rehabilitation after Minimally Invasive Surgery.”

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