An Alternate Technique for Total Hip Surgery: The Direct Anterior Approach.

Total hip replacement surgery commonly performed with one of two methods, direct lateral (from the side) or posterior (from the back). In recent years a previously described technique called the Direct Anterior Approach (DAA) has gathered interest because it is a less invasive procedure. This article by Post, et al, is a description of this procedure, indications for it’s use and difficulties commonly seen with this technique.

This procedure was described as long ago as 1881, however with recent improvements in surgical tools and operating tables specifically for the DAA, it has regained popularity. For the DAA a space in the front of the hip, known as the Heuter interval, is utilized to access the hip joint. Using this space allows the surgeon to avoid cutting through muscle or nerves while replacing the hip. This is argued to decrease pain and improve the speed of recovery following a total hip replacement.

Contraindications for DAA included body mass index above forty due to increased abdominal adipose tissue which presents a challenge for this approach. Another consideration is for patients with previous hip surgery as it is not possible to remove plates that are on the side of the hip or femur with this technique.

This procedure does require significant experience from the surgeon, as most studies have found that complication rates decrease after more than one hundred cases. Other small studies have found less pain and better function at six weeks compared to more traditional approach, however there was no difference by six months. A few other retrospecitive studies have demonstrated reduced pain, but it appears that larger randomized studies are needed to determine if there is an advantage to the DAA.

In summary the DAA technique is a viable option, especially with recent improvements in surgical tools for a successful hip replacement. However more long term research needs to be conducted to determine if there is an advantage in long term outcomes. It is also an approach that requires greater surgical experience to avoid common complications, and should be considered when opting for this procedure.