Direct anterior approach in total hip arthroplasty: a narrative review

Abstract

Objective: Worldwide, a growing number of Total Hip Arthroplasty (THA) procedures are being performed each year. However, despite this significant global demand, the ideal surgical approach remains controversial. Globally there has been a significant increase in the use of direct anterior approach THA. Therefore, the objective of this paper was to synthesise the vast body of new, evolving information into one non-biased narrative review, to provide an overarching review of various aspects of this approach, including controversial issues such as, benefits, functional outcomes, complications, costs, and surgical technique.

Data source: The following keywords were entered into various scientific databases including, Mbase, Google scholar and PubMed. Only articles published in journals between 2017 and 2021 were extracted and included in this review. We found 148 articles published during this period and we used the 82 most relevant articles to collate this narrative review.

Data selection/ extraction: Three fellowship trained arthroplasty orthopaedic surgeons, (JRTP, LM and JC) went through all the papers and selected the 82 most relevant papers for inclusion in this review.

Conclusion: There has been significant interest and renewed vaguer in publication rates by authors worldwide evaluating the use of the DAA in THA. Most recent studies show that there is increasing evidence that the DAA is a safe, reliable, and reproducible surgical approach to THA. Direct anterior approach provides, in the most part, superior early short term functional outcomes in comparison with other THA approaches. It has however also been shown that a steep learning curve exists when using this approach. While complication rates are similar to those seen in other approaches, the types of complications however remain slightly different with an increase incidence of intraoperative peri-prosthetic femoral fractures, wound complications and femoral stem aseptic loosening being significantly greater in the direct anterior approach.