Hip Pelvis.  2017 Dec;29(4):240-246. 10.5371/hp.2017.29.4.240.

Perioperative Comparison of Hip Arthroplasty Using the Direct Anterior Approach with the Posterolateral Approach

• Lee SH
• Kang SW
• Jo S

• KMID: 2424250
• DOI: http://doi.org/10.5371/hp.2017.29.4.240

Abstract

PURPOSE
The aim of the current study is to report the advantage and disadvantage of total hip arthroplasty performed in direct anterior approach (DAA) by comparing it to the posterolateral approach (PLA).
MATERIALS AND METHODS
Twenty-five hip arthroplasty done in DAA (12 total hip arthroplasty [THA] and 13 bipolar hemiarthroplasty [BHA]) were compared with the same number done in PLA (13 THA and 12 BHA). Intraoperative assessments including operation time, anesthetic time, bleeding amount were recorded with intraoperative complications. Immediate postoperatively, position of the prosthesis and leg length discrepancy were measured and were compared between the two approaches.
RESULTS
The operation time was 22 minutes and 19 minutes longer in DAA for THA and BHA respectively while the anesthetic time difference was 26 and 10 respectively. However, these parameters showed no statistical difference. No significance was found when bleeding amount was compared. For DAA, cup alignment was within safe zone in 100% both for inclination and for anteversion while this was 83.3% and 75.0% respectively in PLA. Leg length difference was 3 mm in DAA and 5 mm in PLA but had no significant difference. Tensor fascia lata tear was the most common complication occurring in 9 patients.
CONCLUSION
Although significant was not reached there was trend toward more operation time and anesthetic time when DAA was used. However, the trend also showed that cup and stem were likely to be in more accurate position and in adequate size which is likely due to the accurate use of fluoroscopy.

Keyword

Cup position; Direct anterior approach; Hip arthropalsty; Posterolateral approach; Stem alignment

MeSH Terms

Arthroplasty*
Arthroplasty, Replacement, Hip
Bleeding Time
Butylated Hydroxyanisole
Fascia Lata
Fluoroscopy
Hemiarthroplasty
Hemorrhage
Hip*
Humans
Intraoperative Complications
Leg
Prostheses and Implants
Tears
Butylated Hydroxyanisole

Figure

• 

  Fig. 1 (A) The skin incision is made 2 cm distal and posterior to the ASIS along the TFL. (B) The fasica of the TFL is incised and the muscle portion is exposed. (C) The lateral femoral circumflex artery is identified and ligated. (D, E) anterior capsule is identified and resected to expose femoral head. (F) acetabular reaming is done in routine fashion. (G, H) The neutral rotation of femur is marked (arrow) and the broach is inserted at 15° of anteversion. (I) Routine broaching of the femoral canal is done using dual offset broach handle.

• 

  Fig. 2 The c-arm image of acetabular cup with custom made guide to enhance accuracy of inclination. The arrows indicate 50° mark and the double arrow marks 30°.

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  Fig. 3 (A) Acetabular cup as viewed by c-arm shows elliptic shape due to anteversion. (B, C) With c-arm tilted to 15°, the cup appear as perfect hemisphere.

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