Abstract

Background: The Direct Anterior Approach (DAA) for Total Hip Arthroplasty (THA) has been gaining popularity in recent years because it is the only approach performed in both the intermuscular and the interneural planes. The number of academic articles about DAA is increasing, but still a number of authors continue to question the safety of this approach and its utilization on a day-to-day basis as a standard approach, especially because of the associated steep learning curve. In this article we describe our surgical technique and present lessons learnt from seven years of uniformly excellent experience with DAA.

Materials and Methods: The key technical steps of our surgical technique are described below: namely, surgical exposure, acetabular preparation, femoral preparation, trial reduction and definite prosthesis insertion, wound closure, and rehabilitation. We present DAA with the patient in the supine position on a regular orthopaedic table, both legs are draped free. For femoral exposure, the leg operated upon is placed in the “Figure 1” position.

Result: Between November 2010 and June 2017, we have performed 1528 THA using DAA. In the last year 400 cases, there were 379 primary THA and 21 revisions. Patients are mobilized the same day and the average length of hospitalization is three days. We observe on average ten calcar fractures per year, which can either be merely kept under observation or fixed with a single cortical screw. The rate of prosthesis dislocation is significantly below 0.5% and the rate of deep infection remained as low as with the previous approaches used.

Conclusion: In our opinion, DAA is the best approach for THA because it is the only truly minimally invasive one. It causes fewer dislocations, minimizes postoperative pain and enables faster rehabilitation without the stricter limitations when compared to other approaches.

Keywords: Direct anterior approach; Total hip arthroplasty; Minimally invasive surgery; Learning curve