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Direct Anterior Total Hip Arthroplasty
Patrick F. Bergin, MD1; Anthony S. Unger, MD2
1 Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216. E-mail address: pbergin@umc.edu
2 Washington Orthopaedics and Sports Medicine, 2021 K Street, NW, Suite 400, Washington, DC 20006. E-mail address: ungeranthony@gmail.com
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Based on an original article: J Bone Joint Surg Am. 2011;93:1392-8.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2011 Nov 09;01(03):e15 1-13. doi: 10.2106/JBJS.ST.K.00015
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In theory, the direct anterior approach offers the only path to performing minimally invasive total hip arthroplasty in an intermuscular, internervous plane.

Step 1: Position and Drape Patient

Careful positioning is necessary to complete this procedure on a standard operating room table.

Step 2: Superficial Exposure

Incise the fascia overlying the tensor fasciae latae and lift up the anterior edge, avoiding the perforating vessels.

Step 3: Deep Exposure

The hip is flexed 30° during the deep dissection.

Step 4: Prepare Acetabulum and Implant Acetabular Component

Ream the acetabulum in 10° to 15° of anteversion with an abduction angle of 40° to 45°.

Step 5: Prepare Femur and Implant Femoral Component

Use offset broaches to access the femur and prevent perforation through the greater trochanter.

Step 6: Trial and Close

Specifically check for impingement of bone on the implant with the hip flexed 90°.


This approach has been used successfully for total hip arthroplasty for decades.

What to Watch For



Pitfalls & Challenges

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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