Transition to Anterior Approach in Primary Total Hip Arthroplasty - Learning Curve Complications

Abstract

Introduction: The recent emphasis on tissue preservation and minimally invasive outpatient joint replacements has resulted in a significant increase in the use of Direct Anterior Approach (DAA) total hip arthroplasty. It has gained interest recently because of its faster short-term recovery, despite concerns about increased complications and operative time, especially during the learning curve period. The primary objective of this study was to determine whether complications of transitioning to a direct anterior approach for primary total hip arthroplasty may impair patient safety. Methods: A total of 51 primary hip arthroplasties were performed in 44 patients with the direct anterior approach technique: 37 unilateral arthroplasties and 7 bilateral arthroplasties, during the first 3 years of the learning curve of this technique and their complications were analyzed. Results: No patient had severe complications or surgical reinterventions associated to transoperative complications. Tearing of the tensor fascia lata muscle was on average the most frequent complication (19.6%), followed by skin lesions (17.6%), difficulty in implant reduction (9.8%) and fractures of the greater trochanter (7.8%). No severe complications occurred. Conclusion: This study demonstrates that the transition to the direct anterior approach can be done safely without a significant complication rate. These complications are usually associated with the use of inadequate special instruments, inadequate patient selection and the knowledge of maneuvers of the surgeon and his team acquired during the experience and development of the technique. Even so, they do not require additional treatment, which allows us to conclude that this technique is reproducible and can be safely transitioned.