Abstract
PurposeThe direct anterior approach is an attractive option for total hip arthroplasty (THA) in order to achieve a quicker rehabilitation. However, this surgical technique presents a longer learning curve and a higher complications rate compared with the standard approach. We investigated whether three-dimensional (3D) planning anticipated the surgical difficulties and helped to achieve a low complications rate with respect to intra-operative complications, dislocation risk and lower limb discrepancy (LLD).MethodsOne hundred and fifty-four consecutive patients underwent a primary cementless THA using a direct anterior approach. A 3D planning was performed in order to anticipate the difficulties that may be encountered regarding femur perforation or fracture, dislocation and LLD. All patients were assessed at a mean five years’ follow-up.ResultsNo false route and no fracture occurred at the time of surgery. All the surgical difficulties were anticipated. A motorised reaming procedure of the femur was required in six patients because of a very dense bone or a narrow femur. A retroverted neck was used in 7 % of patients because of a torsional abnormality and enabled an increase in stability. The real implant sizes were the same as the ones planned in 97 % for the cup, 96 % for the stem and 100 % for the neck. At five years’ follow-up, no dislocation occurred, no patient complained about LLD and excellent clinical outcomes were achieved.ConclusionsThis study demonstrates that 3D pre-operative planning-guided THA through a minimally invasive direct anterior approach is a safe and accurate procedure.Level of Evidence: Level IV
Highlights
The direct anterior approach (DAA) is an attractive option for total hip arthroplasty (THA) in order to decrease the dislocation rate [1] and to achieve a quicker rehabilitation [2]
This study demonstrates that 3D pre-operative planning-guided THA through a minimally invasive direct anterior approach is a safe and accurate procedure
With respect to the components size and position, an excellent accuracy was reported with a novel three-dimensional (3D) pre-operative planning technique as the difficulties likely to be encountered were detected and solved pre-operatively by adapting the surgical procedure and choosing the optimal implants which would best restore the hip biomechanics [11,12,13,14]
Summary
The direct anterior approach (DAA) is an attractive option for total hip arthroplasty (THA) in order to decrease the dislocation rate [1] and to achieve a quicker rehabilitation [2]. With respect to the components size and position, an excellent accuracy was reported with a novel three-dimensional (3D) pre-operative planning technique as the difficulties likely to be encountered were detected and solved pre-operatively by adapting the surgical procedure and choosing the optimal implants which would best restore the hip biomechanics [11,12,13,14]. It is not clear whether this technique helped to decrease the complications rate with respect to intra-operative fractures, dislocation risk and complaints about lower limb discrepancy (LLD). No clinical results have yet been reported for this technique
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