The use of the direct anterior approach in total hip arthroplasty can yield good results backed by numerous studies but depends upon proper education, according to one surgeon’s experience.
J. Bohannon Mason, MD, shared his findings at the International Congress for Joint Reconstruction San Diego 2012 meeting, which was held in collaboration with Orthopedics Today.
“The question about the direct anterior (DA) approach is: Is this minimally invasive surgery all over again?” Mason said.
Mason outlined the criteria for a successful approach to total hip arthroplasty (THA), including exposure, visualization, the ability to place either a cemented or cementless implant, the ability to inure stability and an acceptable rehabilitation time.
“The best approach? They all have advantages and disadvantages,” he said. “When you look at [DA], it does require special instrumentation and I would say it does require special training – however, you have quick recovery, stability and proper cup positioning.”
Mason said he prefers the DA approach because “it makes anatomic sense,” noting that dislocation for his patients is a non-issue and bearings are based on tribology rather than stability, so bearing size is optimized and not just the largest that may fit. Mason also noted that the DA approach makes leg length a non-issue and appears to be preferred by patients.
Mason reviewed a series of studies in his presentation, pointing out that the claim for DA with the least supporting evidence appeared to be that of less blood loss. He concluded by noting that surgeon education is key with the DA approach for THA, adding that experience reduces intra-operative complications. He also said he does not believe this is “déjà vu all over again,” referencing previous issues with minimally invasive surgery.
“We need to be responsible with all claims in orthopedics, not simply approach-based claims,” he said. “I do believe the long-term goals of [THA] are optimized with this approach.”
- Mason JB. Why I use the direct anterior THA. Presented at the International Congress for Joint Reconstruction San Diego 2012 in collaboration with Orthopedics Today. April 27-29. San Diego.
- Disclosures: Mason is a consultant for DePuy, Johnson & Johnson and OrthoSensor. He also receives institutional support from DePuy, Stryker, Zimmer and Smith & Nephew.