Two-incisions direct anterior approach for THR: Surgical technique and early outcome

Abstract

PurposeIn recent times the direct anterior approach for total hip replacement has gained considerable interest among orthopaedic surgeons because of the relative muscle-sparing nature than other surgical approaches. However, critics believe that this approach is associated with steep learning curve and high complication rates, mainly attributed to a more limited exposure to the femur. In order to make femoral access easier and implantation of acetabulum in anatomic plane, we designed a “two incisions anterior approach technique” for total hip replacement. The aim of the present study is to determine safety of this technique with respect to perioperative complications as well as early clinical outcome. MethodsA retrospective review is carried out on a consecutive series of patients who underwent primary total hip replacement by the single surgeon through the two incisions direct anterior approach from 01/2014 to 11/2014. We analysed peri-operative complications and clinical outcome at two years’ follow-up. ResultsWe observed 01(0.9%) intra-operative complication; calcar fracture and 01(0.9%) anterior dislocation in first post-operative week. All patients reported improvement of their symptoms. The mean modified oxford hip score was significantly better from 25(11–37), preoperatively to 46.97(33–48) at mean latest follow-up. The mean modified Merle d'Aubigné-Postel score improved to 16.84(12–18) from 9.25 (4–14) preoperatively. ConclusionThe described surgical technique is simple and reproducible technique for easier exposure of femur and insertion of acetabulum in anatomic plane for total hip replacement through direct anterior approach. Easier and better femoral access helps to place implant in anatomical position as well as reduces the risk of femoral fracture associated with inadequate femoral exposure. The added advantage of this technique is, risks of injury to lateral femoral cutaneous nerve can be minimised by careful dissection and isolation of the nerve.