Speaker: Direct anterior approach handles variety of primary, revision THA problems
KOLOA, Hawaii — The direct anterior approach is an adaptable approach that can handle a wide spectrum of primary and revision total hip arthroplasty problems, according to a presenter here at Orthopedics Today Hawaii.
“The anterior THA is not only here to stay but will be the dominant technique in the future. Well guess what? The future has arrived,” Joel M. Matta, MD, said.
Matta said he started doing the direct anterior approach in 1996 because of the risk of dislocation with the posterior approach and the risk of limp with the lateral Harding approach. The adoption of the direct anterior approach has taken off exponentially since the early 2000s, he said. According to a study published in the Journal of Arthroplasty in 2019, 56% of surveyed American Association of Hip and Knee Surgeons members perform the direction anterior approach.
“The growth of the anterior approach – another interesting fact – has taken place despite vocal and continued opposition by most known authorities in hip surgery,” he said.
Anterior THA does not just mean inserting hip components from anterior, Matta said.
“I like to teach it as it evolved. It is the sum total of many small details,” he said.
Matta said new technologies, such as the orthopedic table, will advance hip surgery and the anterior approach. The platform facilitates femoral component placement, limits soft tissue trauma, makes the anterior approach applicable for all patients and helps with radiographic confirmation. Other technologies that will advance the direct anterior approach are the C-arm and software; automated impaction of cup, broach, stem and ball head; collared, tapered, broach-only titanium stems; and cemented stems.
Matta said he uses a tablet PC hardwired to the OR C-arm with digital data so he can look at cup position and adjust it degree by degree.
“This is possible now with the patient supine. This is one of the best things about the anterior approach – getting the patient back supine,” Matta said.
He also uses digital overlays of the right and left hip to adjust leg length and offset millimeter by millimeter in real time during surgery.
“The anterior approach is an extensile and adaptable approach that can handle a wide spectrum of primary and revision THA problems,” Matta said.
The mix of input from science, as well as market forces, will be a positive force to produce the best direction for the future of the anterior approach, he said.
“Going forward, my focus is to prove and improve the best way to do the anterior approach. Certainly, a complete hip surgeon needs to have knowledge of all the approaches of the hip,” he said. – by Kristine Houck, MA, ELS
Matta JM. Direct anterior approach for primary and revision. Presented at: Orthopedics Today Hawaii; Jan. 12-16, 2020; Koloa, Hawaii.
Disclosure: Matta reports he is a consultant for DePuy Synthes, Medtronic and Medacta; receives royalties from MizuhoOSI and DePuy Synthes; and is a stockholder for Anterior Approach Instruments LLC and Radlink.