Recent advances in the direct anterior approach to total hip arthroplasty: a surgeon’s perspective

ABSTRACT

Introduction

The direct anterior approach (DAA) has its origins in the first and oldest approach for hip replacement in the literature, but at the same time it would not be fanciful to suggest its increasing popularity as the latest approach for hip replacement procedures, especially among younger surgeons. However, in a geographical context, the DAA is not considered the major approach in most countries. Moreover, the term DAA encompasses numerous variations in terms of technique.

Areas covered

In this narrative review, we describe our recent experience of advances in the DAA in terms of improved techniques and devices, along with some of its disadvantages. Also, we express our perspective on its future application.

Expert opinions

The DAA is established as one of exemplary approaches to THA. The use of fluoroscopy, the traction table, and appropriate soft tissue management has become essential in the DAA for a safe and trouble-free procedure with adequate patient comfort. With the combination of recent technologies such as robotics, three-dimensional preoperative planning, and artificial intelligence (AI)-based surgeon assist systems, we can look forward to the DAA being performed more efficiently in the future.

KEYWORDS:

• Total hip arthroplasty
• direct anterior approach
• traction table
• fluoroscopy
• learning curve
• lateral femoral cutaneous nerve
• 3S concept
• hip arthroplasty 3.0

Article highlights

• The DAA is established as one of exemplary approaches to THA.

• The use of fluoroscopy, the traction table, and appropriate soft tissue management has become essential in the THA for a safe and trouble-free procedure with adequate patient comfort.

• It is anticipated that the DAA being performed more efficiently with the combination of recent technologies in the future.

Declaration of interest

Y Homma is a consultant for Zimmer-Biomet Japan, Smith and Nephew, Kyocera, and Teijin Nakashima Medical, has received honoraria (lecture fee) from Zimmer-Biomet Japan, Smith and Nephew, and B. Braun Aesculap, received a contract research founding from B Braun Aesculap. T Baba is a consultant for Zimmer-Biomet Japan, and Japan MDM, has received an honoraria (lecture fee) from Zimmer-Biomet, Smith and Nephew, Stryker, Kyocera, and Johnson & Johnson. M Ishijima received a scholarship grant from Zimmer Biomet Japan and B. Braun Aesclup, which were not used for this study. M Ishijima was a representative of endowed departments from several industries, including Zimmer Biomet Japan, Stryker, Japan MDM, and Mathys.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.