Introduction 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 PatientCareful positioning is necessary to complete this procedure on a standard operating room table.
Step 2: Superficial ExposureIncise the fascia overlying the tensor fasciae latae and lift up the anterior edge, avoiding the perforating vessels.
Step 3: Deep ExposureThe hip is flexed 30° during the deep dissection.
Step 4: Prepare Acetabulum and Implant Acetabular ComponentReam the acetabulum in 10° to 15° of anteversion with an abduction angle of 40° to 45°.
Step 5: Prepare Femur and Implant Femoral ComponentUse offset broaches to access the femur and prevent perforation through the greater trochanter.
Step 6: Trial and CloseSpecifically check for impingement of bone on the implant with the hip flexed 90°.
Results This approach has been used successfully for total hip arthroplasty for decades.
What to Watch For Indications
Pitfalls & Challenges
In theory, the direct anterior approach offers the only path to performing minimally invasive total hip arthroplasty in an intermuscular, internervous plane.
Total hip arthroplasty can be safely performed through a number of surgical approaches. Recent interest in improving short-term outcomes has led to a focus on minimally invasive total hip arthroplasty. Classic approaches have been modified and include minimally invasive posterior, lateral, anterior, and two-incision surgical approaches. We present our preferred method of performing a direct anterior minimally invasive total hip arthroplasty.
We currently use the direct anterior surgical approach for the majority of total hip arthroplasties; we use another approach only if specific indications warrant it. We recently reported our results with this technique and compared them with those of a minimally invasive posterior approach1. We found lower levels of …
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