Elsevier

Seminars in Arthroplasty

Volume 23, Issue 3, September 2012, Pages 149-154
Seminars in Arthroplasty

Making the Case for Anterior Total Hip Arthroplasty

https://doi.org/10.1053/j.sart.2012.07.007Get rights and content

Total hip arthroplasty (THA) performed through the Smith–Peterson surgical approach has seen renewed interest among arthroplasty surgeons, as a minimally invasive intervention. Several reports have described the functional outcomes related to direct anterior THA. Most of these have shown that early surgical recovery parameters are improved, with satisfactory component position and an acceptable low risk of complications. Other authors have encountered a higher risk of complications, most often related to surgeon inexperience during early learning. Here, we have summarized the literature pertaining to direct anterior THA, to facilitate informed choices in adopting and learning this technique of THA.

Section snippets

Surgical Technique

The technique used for direct anterior THA has been described previously in the literature by many authors and is summarized here.3, 7, 8, 9 The patient is positioned supine, either on a fracture table or a standard orthopedic table, with the anterior and lateral parts of the operative thigh prepped and draped per surgeon preference. Landmarks include the ASIS, the greater trochanter, and the lateral edge of the ipsilateral patella. Most authors recommend an 8-cm- to 10-cm-long incision,

Comparison With Standard THA

A number of articles have examined a variety of short-term outcomes from anterior THA and compared these with other well-established techniques. These reports and their respective findings are summarized in the following text.

Bhandari et al16 performed a multicenter observational study of single-incision THA across 9 clinical sites in the United States, all of whom used a fracture table, and found an acceptable complication profile with a low dislocation rate and an early return to function.

Complications and Limitations

As a new surgical technique for surgeons accustomed to traditional methods of performing hip replacements, the learning curve and complications anticipated with anterior THA will be of interest. While affirming the role of the direct anterior approach in total hip replacement surgery, Moskal23 recommended cadaver-based learning and surgeon visitation to gain familiarity with the technique and reduce the risk of complications. In 494 primary THAs done using the direct anterior approach on a

Revision Anterior THA

Compared with primary THA with the direct anterior approach, few authors have addressed revision surgery with this technique. Kołodziej et al46 performed revision surgery in a small group of their patients who had previously undergone anterior THA and had hip instability due to component malpositioning. Authors described enlarging the incision and avoiding muscle damage during repeat surgery, although in one case, an additional lateral incision had to be made.46 Mast et al47 described revision

Discussion and Conclusions

Existing data suggest that the anterior surgical approach, based on a modification of the Smith–Peterson surgical interval, is adaptable to primary total hip replacement. A number of centers have reported outcomes that are comparable with the excellent results after THA with other standard techniques, such as the posterior and direct lateral approaches. With the exception of a few authors, most reports describe satisfactory implant positioning with an acceptable incidence of complications.

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  • Cited by (1)

    B.S.B. is a consultant for Zimmer, Inc, Medtronic, Amedica Corporation, and ConforMIS. He is also on the corporate boards for Amedica, OrthoMind, and http://Bonesmart.org, and is business founder and partner in the law firm BalBrenner LLC. No conflicts of interest exist in this manuscript, and authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.

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