Modified Direct Anterior Approach for Total Hip Arthroplasty in an Indonesian Population with Primary Standard Instruments of Total Hip Arthroplasty: Our Experiences and Short-term Follow-up

Eko Medio Septiawan, Claudia Bella Laurentia, Muslich Idris Al Mashur

Abstract


Abstract

Introduction: The direct anterior approach (DAA) for total hip arthroplasty (THA) is a very sophisticated and complicated surgery typically performed using a specialized operating room table and instruments. In our clinic, this procedure was performed with a modified incision to avoid dependence on a special operating room table and we could use ordinary THA instruments. There is an obvious absence of literature regarding this subject.

Methods: A total of 31 patients (31 hips) were recruited for primary THAs from January 1, 2020 to December 31, 2021 who underwent THAs using the DAA in the supine position with modified incision. The technical feasibility and early results were evaluated.

Results: The orientation of the acetabular component average cup inclination was 41.57o ±6.7o, (23o-57o) and the mean cup anteversion was 17.36o ± 5o, (11o-38o). The incidence of neutral coronal femoral stem alignment were 30 hips (97%), varus was 1 (3%), neutral sagittal alignment were 30 hips (97%), and flexion was 1 (3%). The preoperative Harris Hip Score (HHS) was 57.89 points (range: 17-68 points), whereas the postoperative HHS was 89.97 points (range: 82-100 points). There were no postoperative problems such as proximal femur fracture, hematoma, superficial wound complications, deep vein thrombosis, lateral femoral cutaneous nerve damage, heterotopic ossification, loosening of the acetabular component, loosening of the stem, dislocation, infection, or postoperative periprosthetic fracture.

Conclusion: The DAA supine for THA with modified incision may be a valuable alternative in the absence of a special operating room table or special instruments for DAA. This technique also seems to provide satisfactory clinical and radiographic outcomes with acceptable complications in our early follow-up.


Keywords


direct anterior approach, total hip arthroplasty, primary standard instrument

Full Text:

PDF

References


Thaler M, Nogler M, Dammerer D, Ban M, Leitner H, Khosravi I. Femoral revision total hip arthroplasty performed through the interval of the direct anterior approach. J Clin Med. 2021;10(2):1–9.

Post ZD, Orozco F, Diaz-Ledezma C, Hozack WJ, Ong A. Direct Anterior Approach for Total Hip Arthroplasty. J Am Acad Orthop Surg. 2014;22(9):595–603.

Zhao W, Li S, Yin Y, Wang Z, Sun G, Peng X, et al. Direct Anterior Approach in Lateral Decubitus Position Versus Supine Position for Unilateral Total Hip Arthroplasty: A Comparative Study. Orthop Surg. 2021 May;13(3):786–90.

Rajrishi S, Da J, Mahdavi S, P SG, Chen G, Khong H, et al. Annals of Orthopedics and Musculoskeletal Disorders Differences in Outcomes during the Learning Curve of the Anterior Approach Compared to Posterior and Lateral Approaches of Total Hip Arthroplasty : A Retrospective Matched Cohort Study. 2021;4(1).

Rhea EB, Iman DJ, Wilke BK, Sherman CE, Ledford CK, Blasser KE. A Crossover Cohort of Direct Anterior vs Posterolateral Approach in Primary Total Hip Arthroplasty: What Does the Patient Prefer? Arthroplast Today. 2020;6(4):792–5.

Jia F, Guo B, Xu F, Hou Y, Tang X, Huang L. A comparison of clinical, radiographic and surgical outcomes of total hip arthroplasty between direct anterior and posterior approaches: a systematic review and meta-analysis. HIP Int. 2019;29(6):584–96.

Horne PH, Olson SA. Direct anterior approach for total hip arthroplasty using the fracture table. Curr Rev Musculoskelet Med. 2011;4(3):139–45.

Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty. 2013;28(9):1634–8.

Chen M, Luo Z, Ji X, Cheng P, Tang G, Shang X. Direct Anterior Approach for Total Hip Arthroplasty in the Lateral Decubitus Position: Our Experiences and Early Results. J Arthroplasty. 2017;32(1):131–8.

Connolly KP, Kamath AF. Direct anterior total hip arthroplasty: Literature review of variations in surgical technique. World J Orthop. 2016;7(1):38–43.

Moskal JT, Capps SG, Scanelli JA. Anterior muscle sparing approach for total hip arthroplasty. World J Orthop. 2013;4(1):12–8.

Lazaru P, Bueschges S, Ramadanov N. Direct anterior approach (DAA) vs. Conventional approaches in total hip arthroplasty: A RCT meta-analysis with an overview of related meta-analyses. PLoS One. 2021;16(8 August):1–21.

Foissey C, Fauvernier M, Fary C, Servien E, Lustig S, Batailler C. Total hip arthroplasty performed by direct anterior approach - Does experience influence the learning curve? Sicot-J. 2020;6.

Yue C, Kang P, Pei F. Comparison of direct anterior and lateral approaches in total hip arthroplasty: A systematic review and meta-analysis (PRISMA). Med (United States). 2015;94(50):1–10.

Lovell TP. Single-Incision Direct Anterior Approach for Total Hip Arthroplasty Using a Standard Operating Table. J Arthroplasty. 2008;23(7 SUPPL.):64–8.

Abe H, Sakai T, Takao M, Nishii T, Nakamura N, Sugano N. Difference in Stem Alignment Between the Direct Anterior Approach and the Posterolateral Approach in Total Hip Arthroplasty. J Arthroplasty. 2015;30(10):1761–6.

Matta JM, Shahrdar C, Ferguson T. Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthop Relat Res. 2005;441(441):115–24.

Chung YY, Lee SM, Baek SN, Park TG. Direct Anterior Approach for Total Hip Arthroplasty in the Elderly with Femoral Neck Fractures: Comparison with Conventional Posterolateral Approach. CiOS Clin Orthop Surg. 2022;14(1):35–40.

Melman WPR, Mollen BP, Kollen BJ, Verheyen CCPM. First experiences with the direct anterior approach in lateral decubitus position: Learning curve and 1 year complication rate. HIP Int. 2015;25(3):251–7.

Hamilton WG, Parks NL, Huynh C. Comparison of Cup Alignment, Jump Distance, and Complications in Consecutive Series of Anterior Approach and Posterior Approach Total Hip Arthroplasty. J Arthroplasty. 2015;30(11):1959–62.

Moerenhout K, Derome P, Yves Laflamme G, Leduc S, Gaspard HS, Benoit B. Direct anterior versus posterior approach for total hip arthroplasty: a multicentre, prospective, randomized clinical trial. Can J Surg. 2020;63(5):E412–7.

Maeda Y, Sugano N, Nakamura N, Hamawaki M. The Accuracy of a Mechanical Cup Alignment Guide in Total Hip Arthroplasty (THA) Through Direct Anterior and Posterior Approaches Measured with CT-Based Navigation. J Arthroplasty. 2015;30(9):1561–4.

Danoff JR, Bobman JT, Cunn G, Murtaugh T, Gorroochurn P, Geller JA, et al. Redefining the Acetabular Component Safe Zone for Posterior Approach Total Hip Arthroplasty. J Arthroplasty. 2016;31(2):506–11.

Smolle MA, Fischerauer SF, Maier M, Reinbacher P, Friesenbichler J, Ruckenstuhl P, et al. Leg length measures appear inaccurate in the early phase following total hip arthroplasty. Sci Rep. 2021;11(1):1–9.

Allegrone J, Green J, Nicoloro D, Heislein DM, Eisemon EO, Savidge ET, et al. Physical Rehabilitation after Total Hip Arthroplasty. Second Edi. Pathology and Intervention in Musculoskeletal Rehabilitation. Elsevier Inc.; 2016. 692–712 p.

Haversath M, Busch A, Jäger M, Tassemeier T, Brandenburger D, Serong S. The “critical trochanter angle”: A predictor for stem alignment in total hip arthroplasty. J Orthop Surg Res. 2019;14(1):1–6.

Min BW, Song KS, Bae KC, Cho CH, Kang CH, Kim SY. The Effect of Stem Alignment on Results of Total Hip Arthroplasty with a Cementless Tapered-Wedge Femoral Component. J Arthroplasty. 2008;23(3):418–23.




DOI: https://doi.org/10.46355/hipknee.v4i1.147

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

The Knee and Hip Journal has been indexed and abstracted in the following databases: