Advantage of the anterior approach in total hip arthroplasty (topographic-anatomical and computed tomography substantiation)

Abstract

BACKGROUND: Hip arthroplasty is effectively performed for the elderly population and young people who continue to work and have an active lifestyle. An increase in the number of operations is facilitated by an increase in the prevalence of osteoarthritis and physical inactivity, leading to an increase in BMI and, accordingly, the load on the joints of the lower extremities. The increased volume of hip arthroplasty, the expansion of indications, the decrease in the average age of patients undergoing the intervention, and the related increase in surgical needs point to the need to improve surgical treatment approaches. In the CIS countries, the direct anterior approach is rarely used; in our opinion, it is less traumatic.
 OBJECTIVE: To conduct a topographic-anatomical and computed tomographic study to support the advantages of using a direct anterior approach when performing hip arthroplasty.
 MATERIALS AND METHODS: The present study included two stages: First, (a) layer-by-layer anatomical preparation of the hip joint area on five sectional complexes to establish accurate anatomical and topographic relationships of the structures of the anterior thigh region and design accesses and (b) hip arthroplasty on 10 biomannequins using two approaches: five operations (direct anterior approach) and five operations (direct lateral approach), and second, evaluation of access to the hip joint in terms of criteria developed by A.Yu. Sazon-Yaroshevich to assess online access.
 RESULTS: This study confirmed that the direct anterior approach is less traumatic; its use preserves soft tissues. However, the use of a direct anterior approach requires additional training of endoprosthetic surgeons. The authors recommend executing the first 1020 endoprostheses on biomanikins to link the risk of problems and to solidify surgical skills at the beginning of the learning curve. The depth of the wound is 2025% less with the direct anterior approach to the hip joint than with the Harding approach 101 and 136 mm, respectively.
 CONCLUSION: Because the approach to the joint is carried out along the intermuscular gap, no soft tissues, blood vessels, or nerves are damaged during the direct anterior approach. According to its characteristics, the direct anterior approach is optimal for performing hip arthroplasty. Maintaining muscles during the performance of the direct anterior approach allows you to begin early activation and rehabilitation of patients. The adoption of a direct anterior approach is related to improved hip joint functional results in the early postoperative period.