Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Direct Anterior Approach in Total Hip Arthroplasty: A Single Center Experience

  • Rajesh Malhotra (Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS)) ;
  • Sahil Batra (Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS)) ;
  • Vikrant Manhas (Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS)) ;
  • Jaiben George (Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS)) ;
  • Anitta Biju (Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS)) ;
  • Deepak Gautam (Department of Orthopaedics, Medicover Hospitals)
  • Received : 2023.11.15
  • Accepted : 2024.02.26
  • Published : 2024.09.01
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Abstract

Purpose: The direct anterior approach (DAA) for conducting total hip arthroplasty (THA) is gaining popularity worldwide. However, careful selection of patients and surgeon experience are important. Although promising outcomes have been reported in international studies, research on DAA in Southern and Southeast Asia has been limited. Materials and Methods: This prospective study included 157 patients who underwent THA using the DAA between January 2019 and June 2022. The patients were divided into three groups for the comparison. Data on preoperative, intraoperative, and postoperative variables were acquired. Improvement of the surgeon's performance to use of a DAA approach was examined using the CUSUM (cumulative summation method). Results: The mean age of the patients was 43.9 years. Differences in intraoperative variables and complications were observed among the three groups, and improved outcomes were reported in later cases. Functional outcomes showed significant improvement, and no differences were observed between groups. The results of learning curve analysis indicated a shift towards consistent success after the 82nd case, reaching an acceptable rate of failure by the 118th case. Conclusion: The findings of this study suggest that DAA can offer benefits but there is a learning curve. Complications were initially high but began decreasing after approximately 80 cases. Careful selection of patients is critical, particularly in the effort to minimize being presented with a challenging case. This study provides insights that may be helpful to surgeons when considering DAA; however, further study is warranted.

Keywords

References

  1. Learmonth ID, Young C, Rorabeck C. The operation of the century: total hip replacement. Lancet. 2007;370:1508-19. https://doi.org/10.1016/S0140-6736(07)60457-7
  2. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780-5. https://doi.org/10.2106/JBJS.F.00222
  3. Paillard P. Hip replacement by a minimal anterior approach. Int Orthop. 2007;31(Suppl 1):S13-5. https://doi.org/10.1007/s00264-007-0433-7
  4. Jones CA, Beaupre LA, Johnston DW, Suarez-Almazor ME. Total joint arthroplasties: current concepts of patient outcomes after surgery. Rheum Dis Clin North Am. 2007;33:71-86. https://doi.org/10.1016/j.rdc.2006.12.008
  5. Chechik O, Khashan M, Lador R, Salai M, Amar E. Surgical approach and prosthesis fixation in hip arthroplasty world wide. Arch Orthop Trauma Surg. 2013;133:1595-600. https://doi.org/10.1007/s00402-013-1828-0
  6. Post ZD, Orozco F, Diaz-Ledezma C, Hozack WJ, Ong A. Direct anterior approach for total hip arthroplasty: indications, technique, and results. J Am Acad Orthop Surg. 2014;22:595-603. https://doi.org/10.5435/JAAOS-22-09-595
  7. Kong X, Grau L, Ong A, Yang C, Chai W. Adopting the direct anterior approach: experience and learning curve in a Chinese patient population. J Orthop Surg Res. 2019;14:218. https://doi.org/10.1186/s13018-019-1272-0
  8. Peters RM, Ten Have BLEF, Rykov K, et al. The learning curve of the direct anterior approach is 100 cases: an analysis based on 15,875 total hip arthroplasties in the Dutch Arthroplasty Register. Acta Orthop. 2022;93:775-82. https://doi.org/10.2340/17453674.2022.4802
  9. Rhatomy S, Rasyid FA, Phatama KY. The direct anterior approach in total hip arthroplasty: publication trends of Asian countries on PubMed. Ann Med Surg (Lond). 2020;55:280-6. https://doi.org/10.1016/j.amsu.2020.06.001
  10. Crowe JF, Mani VJ, Ranawat CS. Total hip replacement in congenital dislocation and dysplasia of the hip. J Bone Joint Surg Am. 1979;61:15-23.
  11. Goodman GP, Goyal N, Parks NL, Hopper RH Jr, Hamilton WG. Intraoperative fluoroscopy with a direct anterior approach reduces variation in acetabular cup abduction angle. Hip Int. 2017;27:573-7. https://doi.org/10.5301/hipint.5000507
  12. Rivera F, Comba LC, Bardelli A. Direct anterior approach hip arthroplasty: how to reduce complications - a 10-years single center experience and literature review. World J Orthop. 2022;13:388-99. https://doi.org/10.5312/wjo.v13.i4.388
  13. Heinz T, Vasilev H, Anderson PM, et al. The direct anterior approach (DAA) as a standard approach for total hip arthroplasty (THA) in coxa profunda and protrusio acetabuli? A radiographic analysis of 188 cases. J Clin Med. 2023;12:3941. https://doi.org/10.3390/jcm12123941
  14. Sang W, Zhu L, Ma J, Lu H, Wang C. The influence of body mass index and hip anatomy on direct anterior approach total hip replacement. Med Princ Pract. 2016;25:555-60. https://doi.org/10.1159/000447455
  15. Ramadanov N, Bueschges S, Lazaru P, Dimitrov D. A metaanalysis on RCTs of direct anterior and conventional approaches in total hip arthroplasty. Sci Rep. 2021;11:20991. https://doi.org/10.1038/s41598-021-00405-4