Direct Anterior Total Hip Arthroplasty.

Abstract

In theory, the direct anterior approach offers the only path to performing minimally invasive total hip arthroplasty in an intermuscular, internervous plane. Careful positioning is necessary to complete this procedure on a standard operating room table. Incise the fascia overlying the tensor fasciae latae and lift up the anterior edge, avoiding the perforating vessels. The hip is flexed 30° during the deep dissection. Ream the acetabulum in 10° to 15° of anteversion with an abduction angle of 40° to 45°. Use offset broaches to access the femur and prevent perforation through the greater trochanter. Specifically check for impingement of bone on the implant with the hip flexed 90°. This approach has been used successfully for total hip arthroplasty for decades. IndicationsContraindicationsPitfalls & Challenges.