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World J Orthop. Feb 18, 2016; 7(2): 94-101
Published online Feb 18, 2016. doi: 10.5312/wjo.v7.i2.94
Direct anterior total hip arthroplasty: Comparative outcomes and contemporary results
Keith P Connolly, Atul F Kamath
Keith P Connolly, Atul F Kamath, Department of Orthopedic Surgery, Center for Hip Preservation, Penn Medicine, University of Pennsylvania, Philadelphia, PA 19107, United States
Author contributions: Connolly KP and Kamath AF contributed to this paper.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose pertaining to the subject of this review manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Atul F Kamath, MD, Department of Orthopedic Surgery, Center for Hip Preservation, Penn Medicine, University of Pennsylvania, 800 Spruce Street, 8th Floor Preston, Philadelphia, PA 19107, United States. akamath@post.harvard.edu
Telephone: +1-215-6878169 Fax: +1-215-8292492
Received: May 29, 2015
Peer-review started: June 2, 2015
First decision: September 29, 2015
Revised: October 25, 2015
Accepted: December 3, 2015
Article in press: December 4, 2015
Published online: February 18, 2016
Processing time: 263 Days and 5.5 Hours
Abstract

Direct anterior total hip arthroplasty has become increasingly more popular among arthroplasty surgeons, in large part due to the use of an intramuscular interval and desire to reduce soft tissue damage. Several studies have now been published comparing the anterior intramuscular to other commonly used approaches, and many studies have published complication rates on large series of patients. Review of comparative studies indicates direct anterior hips tend towards shorter hospital stays and high rates of patients discharged to home. Although some studies show evidence of early benefit in functional outcomes, there is no strong evidence that the anterior approach provides any long term functional improvements compared to other approaches. Additionally, evidence to support reduced damage to soft tissue may not translate to certain clinical significance. Rates of intra-operative femur fracture, operative time and blood loss rates are notably higher for those developing familiarity with this approach. However, when surgeons have performed a modest number of procedures, the complication rates tend to markedly decrease in most studies to levels comparable to other approaches. Accuracy of component positioning also favors the anterior approach in some studies. This review summarizes the available literature comparing the direct anterior to other approaches for total hip arthroplasty and provides a comprehensive summary of common complications.

Keywords: Complications; Direct anterior approach; Surgical hip approaches; Outcomes; Total hip arthroplasty

Core tip: Direct anterior total hip arthroplasty may provide higher rates of patients discharged to home and shorter hospital stays when compared to other approaches. Long term functional outcomes do not appear to be improved by an intramuscular approach. Complication rates may be high during the initial learning period of performing this approach; however, these rates are generally shown to not exceed that of other approaches once a surgeon has completed a modest number of cases.