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