Approach For Total Hip Replacement Research Articles

Functional and Clinical outcomes of total hip replacement surgery via Lateral approach

Background: Total hip arthroplasty (THA) is a critical surgical intervention for patients with severe hip dysfunction primarily due to conditions such as osteoarthritis, trauma, and other degenerative diseases. The choice of surgical approach can significantly influence the outcomes of the procedure, including postoperative recovery, pain management, and functional mobility. Objective: This study aims to evaluate the clinical and functional outcomes of the lateral approach in total hip replacement, comparing its efficacy and safety with other surgical techniques. Methods: A retrospective cohort study was conducted at a single medical teaching institution, involving 74 patients who underwent total hip replacement using the lateral approach between January 2022 and December 2023. Data were collected on patient demographics, surgical details, and postoperative outcomes. Key measures included the Harris Hip Score (HHS), rates of postoperative pain, limb length discrepancy (LLD), and complications such as dislocation and infection. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 25, with a significance threshold set at P < 0.05. Results: The study population had an equal distribution of male and female patients, with an average age of 57.20 years (SD ± 14.68). Trauma was the most common indication for surgery (67.6%), followed by osteoarthritis (18.9%) and avascular necrosis (9.5%). Postoperative evaluation showed that 62.26% of patients achieved an 'excellent' HHS at two weeks, while 28.38% were rated as 'good'. The overall complication rate was low, with dislocation occurring in 4.1% of cases. Pain was reported in 12.2% of patients post-surgery. Conclusion: The lateral approach for total hip arthroplasty provides effective pain relief and functional recovery with a low complication rate. This study supports the continued use of the lateral approach as a viable option for hip replacement surgery, showing comparable or superior outcomes to other surgical approaches.

A new minimal-invasive approach for total hip replacement in sheep.

Over the last 50 years arthroplasty became the gold-standard treatment for disabling conditions of the coxofemoral joint. Variations of anterior, lateral, and dorsal incision have been applied, but as each approach requires the incision and reflection of various muscles to gain adequate exposure of the joint results are still controversial. The purpose of this study was to develop a minimal-invasive, tissue-sparing approach in sheep with reduced risks in animal testing. 12 mature sheep underwent hip surgery as part of a study to evaluate a hip resurfacing system. In line with the preliminary cadaveric tests a modified, minimal-invasive, musclepreserving surgical approach was sought after. We developed a surgical approach to the coxofemoral joint in sheep using only blunt tissue dissection after skin incision without any limitations in joint exposure or increased blood loss/duration of surgery. Even though limitations occur and femoral orientation in sheep differs from man, joint forces have similar relative directions to the bone with similar bony and vascular anatomy. Therefore, this minimal-invasive muscle preserving approach might be a safe and comparable alternative in still inevitable animal testing.

Efficacy of Direct Anterior Approach Versus Posterior Lateral Approach for Total Hip Replacement in Patients with Parkinson's Disease.

BACKGROUND The present study was performed to evaluate the efficacy of direct anterior approach (DAA) versus posterolateral approach (PLA) for total hip arthroplasty (THA) in patients with Parkinson's disease (PD). The aim of the study was to compare the speed of recovery of hip function and postoperative complications between the 2 approaches. MATERIAL AND METHODS The study included 285 Parkinson's patients who underwent THA; 209 eligible patients were recruited for analysis as per the inclusion criteria and assigned into DAA group (n=90) and PLA group (n=119) according to the surgical approach. Postoperative Harris Hip Score (HHS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and Forgotten joint score (FJS) were collected to assess hip function. RESULTS The DAA had a statistically lower incidence of postoperative complications than the PLA, particularly the rate of postoperative dislocation. Perioperative outcomes showed a longer operative time in the DAA than in the PLA group and more intraoperative blood loss in the DAA than in the PLA group. At 3 months postoperatively, the HHS and WOMAC scores in the DAA group showed significantly higher scores compared to the PLA group versus the DAA group. However, these differences disappeared at 6 months postoperatively and the FJS in the DAA group had a statistically higher score compared to the PLA group. CONCLUSIONS In patients with Parkinson's disease complicated with hip disease, the DAA approach exhibited a lower rate of dislocation than the PLA approach and had faster recovery of hip function.

Comparison of DAA and PLA Approaches for Total Hip Replacement in the Treatment of Femoral Neck Fractures

Objectives: Femoral neck fractures are becoming more common within nowadays. This research is to explore the clinical effect of primary total hip replacement (THA) via direct anterior approach (DAA) and posterolateral approach (PLA) in the treatment of femoral neck fracture. Methods: Retrospective analysis of 100 cases of elderly patients with femoral neck fracture who underwent total hip arthroplasty admitted to Tianyou Hospital affiliated to Wuhan University of Science and Technology from January 2019 to January 2022. 50 patients treated with DAA approach were included in the observation group, and 50 patients treated with PLA approach were included in the control group. The operation indexes, postoperative acetabular abduction angle and anteversion angle, hip joint function, Harris score and complications were compared between the two groups. Result: The length of incision in the observation group was shorter than that in the control group, and the amount of intraoperative bleeding and postoperative hospital stay were shorter than those in the control group (P 0.05); Harris score of hip joint: 6 months after operation, the anterior approach group was significantly higher than the posterolateral approach group (P 0.05); The total incidence of complications in the observation group was lower than that in the control group, with a statistically significant difference (P Conclusion: DAA and PLA approaches for total hip replacement can restore the hip joint structure of patients with femoral neck fractures and achieve good results, but DAA approach has greater advantages in early postoperative recovery, improvement of hip joint function, small surgical injury, high application value, so it is recommended.

An audit on the accuracy of freehand acetabular cup positioning in total hip arthroplasty with the direct lateral approach at a tertiary institution over seven years

BACKGROUND: The direct lateral approach for total hip replacement has been traditionally reserved and described for neck of femur fractures. Advantages of this approach include technically easy access to the acetabulum and femur and low incidence of hip dislocation. Imperfect positioning of the acetabular component leads to increased risk for dislocations, accelerated wear, reduced range of motion and increased revision rate. Freehand technique has been the gold standard for many decades, but newer technologies like computer navigation and robotic-assisted surgery have shown to improve the accuracy of cup placement. This study reports on the accuracy of freehand cup positioning via the direct lateral approach with mention of the dislocation rate METHODS: We retrospectively reviewed 253 patients who had total hip replacements done via the direct lateral approach. The patients' files were evaluated for patient parameters, demographic details, aetiology of hip pathology, confirmation of approach used, comorbidities and history of previous relevant surgery. The postoperative radiographs were analysed for acetabular component position inclination and anteversion. Dislocation rates were calculated as a secondary objective RESULTS: The radiographic analysis was performed using the Liaw method based on trigonometry of the eclipse generated. This showed a mean cup inclination of 42.3° (95% CI: 41.3-43.3°) and anteversion of 12.7° (95% CI: 12.0-13.7°). A total of 57% of the acetabular cups were within the safe zones described by Lewinnek. Of them, 78% were in the 30-50° range for inclination and 73% in the 5-25° range for anteversion. There were ten dislocations within one year from the index procedure: a dislocation rate of 4.0% (95% CI: 2.8-8.5% CONCLUSION: The freehand technique using the direct lateral approach for acetabular cup placement produces a poor overall accuracy of only 57%. Although our study only commented on ten dislocations, the rate (4%) is significantly worse compared to the 0.43% reported in literature for the direct lateral approach. The radiographic results for inclination and anteversion are comparable to other freehand techniques, regardless of the approach used, but significantly worse than results achieved with navigation and robotics Level of evidence: Level 4

Direct anterior approach vs. SuperPATH vs. conventional approaches in total hip replacement: A network meta-analysis of randomized controlled trials

BackgroundTwo minimally invasive approaches showed some advantages in outcomes compared to conventional approaches (CAs) – the direct anterior approach (DAA) and the supercapsular percutaneously assisted approach in THA (SuperPATH). To the best of our knowledge, these three approaches have never been ranked in a network meta-analysis (NMA) before. Therefore, we conducted a systematic review and NMA of randomized controlled trials comparing short-term outcomes of DAA, SuperPATH and CAs in total hip joint arthroplasty (THA), using CAs as common comparator. MethodsA systematic literature search up to February 2021 was performed to identify randomized controlled trials (RCTs) comparing DAA with CAs and SuperPATH with CAs in THA. We measured surgical, functional and radiological outcomes. A NMA, using frequentist methods was performed to assess treatment effects between DAA, SuperPATH and CAs. Information was borrowed from the above-mentioned RCTs, using the CA group as a common comparator. ResultsA total of 24 RCTs involving 2,074 patients met the inclusion criteria, six trials with a level I evidence, 18 trials with level II evidence. SuperPATH reduced operation time (fixed effects model: MD=8.1, 95% CI: 5.7 to 10.4), incision length (fixed effects model: MD=2.7, 95%CI: 2.5 to 2.9; random effects model: MD=4.1, 95%CI: 0.6 to 7.6), intraoperative blood loss (fixed effects model: MD=157, 95%CI: 139.2 to 174.2; random effects model: MD=129, 95%CI: 11.5 to 245.7) and early pain intensity (VAS 1 day postoperatively with a fixed effects model: MD=0.8, 95%CI: 0.4 to 1.2) compared to DAA. The two approaches did not differ in functional outcome and in acetabular cup inclination positioning. ConclusionsOur overall findings suggest that short-term outcomes of THA through SuperPATH were superior to DAA and CAs and that short-term outcomes of THA through DAA were superior to CAs. Level of evidenceII; systematic review with level I studies and level II studies.

Changes in Invasiveness and Latent Infection Rate Associated with Switching the Approach in Total Hip Replacement.

Purpose:Muscle-sparing approaches for total hip replacement (THR) involve learning curves. This study aimed to clarify changes in invasiveness and infection rate with changes in approach.Methods:One surgeon changed the approach of THR from Dall’s approach (Dall) to anterolateral modified Watson-Jones approach (OCM). Another changed from Dall to a direct anterior approach (DAA). Another 3 surgeons changed from posterolateral approach (PL) to OCM. Subjects were 150 cases, comprising the last 25 cases with conventional approaches and the first 25 cases with new approaches (Dall to OCM: 25 + 25; Dall to DAA: 25 + 25; PL to OCM: 25 + 25 cases). Differences in operative time, bleeding volume, hospital stay, haemoglobin (Hb), white blood cell count, lymphocyte count, creatine kinase (CK) and C-reactive protein (CRP) were investigated.Results:In the change from Dall to OCM, only hospital stay decreased. In the change from Dall to DAA, hospital stay and CRP decreased, but bleeding volume increased. In the change from PL to OCM, operative time, CRP and CK decreased, but Hb also decreased. Cases with lymphocyte count <1000/μL or lymphocytes comprising <10% of total white blood cells at around day 4 after surgery were defined as latent infection cases. In these cases, operative time was longer, Hb was lower and CK was higher.Conclusion:Introducing muscle-sparing approaches improved many markers of invasiveness, but some items deteriorated. In the early stages of introducing a new approach, choosing cases without obesity and without high muscle volume may reduce the risk of infection.

Supercapsular Percutaneously Assisted total hip arthroplasty versus lateral approach in Total Hip Replacement. A prospective comparative study

BackgroundSupercapsular Percutaneously Assisted total hip arthroplasty (SuperPATH approach) is a relatively new minimal invasive approach which has been associated with encouraging postoperative outcomes. The aim of this study is to compare the minimal invasive (MIS) SuperPATHapproach with the standard modified Hardinge approach at the base of muscle damage due to serum markers, functional results and other perioperative and postoperative data. Material and methodsForty eight (48) consecutive patients undergone primary total hip arthroplasty (THA) by the same surgeon (GD), were enrolled in our study. From this study population, the modified Hardinge approach was performed in 23 patients and the SuperPATH approach was performed in 25 patients. Soft tissue impairment was studied based on three representative markers, C-reactive-protein (CRP) and two enzymes, creatine kinase (CK) and lactate dehydrogenase (LDH). We measured these markers 10 min after surgery, on 1st and 2nd postoperative day. The levels of the perceived pain were evaluated according to the Visual Analog Scale/Numerical Rating Scale (VAS/NRS) score which was registered 6 h, 12 h, 1 day and 2 days postoperatively. The functional and clinical evaluation of the patients was achieved with Harris Hip Score (HHS), Charnley's Hip score, EuroQol (EQ-5D)-(EQ-100), Patient Health Questionnaire (PHQ-9) and neuropathic pain questionnaire (DN-4) 6 months and 1 year postoperatively. The rest of the collected data included patient's age, gender, body mass index (BMI), other comorbitities, the American Society of Anesthiologists score (ASA), Charlson Index score, the pre-operative diagnosis, implant positioning through radiographic evaluation, the type of anesthesia, the days of hospitalization, the operating time, incision length, blood loss and blood transfusion requirements and complication rates. ResultsSuperPATH approach was related with statistically considerable lower levels of CRP at 10 min (p = 0,001) and at 24 h (p = 0,047) postoperatively, as well as lower LDH levels in all time points postoperatively. It was also associated with shorter incision length (p < 0.001), longer operating time (p < 0.001), higher mean cup inclination p < 0.001, decreased postoperative pain levels the first 6 and 12 h (p < 0.001) and relatively better clinical and functional results 6 months after surgery, but not at 12 months. ConclusionOur study revealed some advantages in favor of the SuperPATH approach comparing with the standard modified Hardinge approach, mainly in terms of less muscle damage and less perceived pain postoperatively. More research is required in order to further elucidate its efficacy.

The effect of surgical approach in total hip replacement on outcomes: an analysis of 723,904 elective operations from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man

BackgroundTotal hip replacement (THR) is clinically and cost-effective. The surgical approach employed influences the outcome; however, there is little generalisable and robust evidence to guide practice.MethodsA total of 723,904 primary THRs captured in the National Joint Registry, linked to hospital inpatient, mortality and patient-reported outcome measures (PROMs) data with up to 13.75 years follow-up, were analysed. There were seven surgical approach groups: conventional posterior, lateral, anterior and trans-trochanteric groups and minimally invasive posterior, lateral and anterior. Survival methods were used to compare revision rates and 90-day mortality. Groups were compared using Cox proportional hazards and Flexible Parametric Survival Modelling (FPM). Confounders included age at surgery, sex, risk group (indications additional to osteoarthritis), American Society of Anesthesiologists grade, THR fixation, thromboprophylaxis, anaesthetic, body mass index (BMI) and deprivation. PROMs were analysed with regression modelling or non-parametric methods.ResultsUnadjusted analysis showed a higher revision risk than the referent conventional posterior for the conventional lateral, minimally invasive lateral, minimally invasive anterior and trans-trochanteric groups. This persisted with all adjusted FPM and adjusted Cox models, except in the Cox model including BMI where the higher revision rate only persisted for the conventional lateral approach (hazard rate ratio (HRR) 1.12 [95% CI 1.06,1.17] P < 0·001) and trans-trochanteric approaches (HRR 1.48 [95% CI 1.14,1.91] P = 0.003). PROMs demonstrated statistically, but not clinically, significant differences. Self-reported complications were more frequent with the conventional lateral approach, and the risk of 90-day mortality was higher (HRR 1.15 [95%CI 1.01–1.30] P = 0.029).ConclusionsLateral approaches for THR are associated with worse outcomes, including more deaths and revisions, than the posterior approach. We recommend the posterior approach should be considered the current standard approach for THR. Large well-designed studies are needed to assess any potential benefits from using minimally invasive posterior approaches and the conventional anterior approach.

Debridement, Antibiotics, and Implant Retention with the Direct Anterior Approach for Acute Periprosthetic Joint Infection Following Primary THA.

Background:Periprosthetic joint infection (PJI) is a devastating complication following total hip replacement. The direct anterior approach for total hip replacement is becoming increasingly popular. However, little is known about the success rate of treatment with debridement, antibiotics, and implant retention (DAIR) using the direct anterior approach. The aim of this study was to analyze the effectiveness of DAIR using this approach and identify patient and surgical factors that influence the results.Methods:Seventy-four patients (75 hips) in whom DAIR had been performed were identified from the records of the weekly multidisciplinary infection meeting and the laboratory information management systems. In 4% (3 hips), modular components were exchanged. To consider competing risks (death), we used competing risk models.Results:The competing risk analysis showed a successful outcome after DAIR of 82% at 4 years of follow-up; this rate was 89% at 4 years follow-up when excluding patients managed with gentamicin beads. The sensitivity analysis revealed that obesity (body mass index [BMI] of ≥30 kg/m2), use of gentamicin beads, and an erythrocyte sedimentation rate (ESR) of >40 mm/hr increased the risk of failure.Conclusions:DAIR using the direct anterior approach without the routine exchange of modular components offers a success rate that is comparable with other approaches for eradicating acute PJI following primary hip arthroplasty.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Contemporary posterior surgical approach in total hip replacement: still more reoperations due to dislocation compared with direct lateral approach? An observational study of the Swedish Hip Arthroplasty Register including 156,979 hips

Background and purpose — The direct lateral approach (DLA) and the posterior approach (PA) are the most common surgical approaches in total hip replacement (THR) in Sweden. We investigated how the relationship between surgical approach and risk of reoperation due to dislocation has evolved over time.Patients and methods — Data were extracted from the Swedish Hip Arthroplasty Register from 1999 to 2014. We selected all THRs due to osteoarthritis with head sizes 28, 32, and 36 mm that were performed with either the DLA or the PA. Resurfacing prostheses were excluded. Kaplan–Meier curves for risk of reoperation due to dislocation and all-cause for the 2 surgical approaches were compared for 2 periods (1999–2006 and 2007–2014) up to 2 years postoperatively. We used Cox regression for sex, age, type of fixation, and head size to determine hazard ratios (HR) with DLA set as reference.Results — 156,979 THRs met the selection criteria. In 1999–2006, the PA was associated with increased risk of reoperation due to dislocation (HR 2.3, 95% CI 1.7–3.0) but there was no difference in the risk of all-cause reoperation (HR 1.1, CI 0.9–1.2). In 2007–2014 there was no statistically significant difference in the risk of reoperation due to dislocation (HR 1.2, CI 0.9–1.6) but the risk of all-cause reoperation was lower (HR 0.8, CI 0.7–0.9) for the PA.Interpretation — This study confirms historic reports on the increased risk of early reoperations due to dislocations using the PA compared with the DLA. However, in contemporary practice, the higher risk of reoperation due to dislocation associated with PA has declined, now being similar to that after DLA. We believe improved surgical technique for the PA may explain the results. Surprisingly, the PA was associated with lower risk of all-cause reoperation in 2007–2014. This finding warrants further investigation.

The Learning Curve of the Direct Anterior Approach without Traction Table in Total Hip Replacement: Using the LC-CUSUM Method

AbstractThe surgical approach for total hip replacement (THR) depends on surgeon preference or the preference and experience of the surgeon with a specific approach. The aim of this study was to analyze the learning curve of the direct anterior approach (DAA) using the cumulative summation test for learning curve (LC-CUSUM). A retrospectively collected database of 400 THRs using the DAA (January 2010–September 2014) at a single center by a single surgeon. The learning curve was analyzed by determining the duration of surgery, blood loss, and number of complications. All 400 primary THRs were reviewed. Based on the LC-CUSUM, duration of surgery, and surgical failure, the learning curve plateau was achieved after the 19th surgery and the curve follows a substantially negative trend. The average duration of surgery changed significantly for the first hundred (78 minutes) to the last hundred (61 minutes). A significant decrease in blood loss was observed as well. A total of 17 (4.25%) complications occurred, with reduction of the complication rate as surgeons' experience increases. The authors' study did not show the long learning curve as previously described in the literature. The number of complications was small, and there was a significant decrease in duration of surgery, blood loss, and number of complications as surgeon's experience increases. The authors suggest that the educational environment of a teaching hospital, combined with the use of the DAA as a standard approach for all primary THRs and supervision of experienced surgeons, contribute to the favorable learning curve with a low complication rate.

Tension-free closure with capsular lengthening in mini posterior total hip replacement.

Choice of the best mini invasive surgical approach for total hip replacement remains a controversial topic. The posterior approach is traditionally associated with a higher dislocation rate and the obligation of postoperative restrictions. Soft tissue repair reduces the risk of dislocation yet, posterior closure it is often challenging because of capsular and external rotator contractures. In this article, an original procedure of capsular lengthening and tension-free closure is described and the results of a retrospective single surgeon series of minimally invasive posterior total hip replacement (THR) with capsular repair are presented. A total of 925 mini posterior total hip replacements performed between 2009 and 2015 were retrospectively reviewed. 2 original types of capsulorrhaphy to decrease tension of the repaired tissues were employed. Absence of posterior envelope stretch during flexion and internal rotation was confirmed intraoperatively with a dynamic test. No postoperative restrictions were used. Capsular lengthening with 1 of the described techniques was required in over 50% of cases for a tension-free closure. 3 patients dislocated in the 867 reviewed procedures (0.35%), 1 requiring revision for instability (0.11%). This soft tissue repair technique after mini posterior approach THR is technically easy, provides a tension-free closure and a low dislocation rate.

The gripper table mounted retraction system: A tireless surgical assistant

The Gripper Table Mounted System (Gripper™) is comprised of a pulley system that is table mounted on attachable posts and can be used to provide retraction in place of surgical assistants. It accepts flat handled retractors and provides constant retraction. It can be particularly helpful during surgeries that require multiple surgical hands such as the direct anterior approach for total hip replacement. The system is adaptable and can be used in a variety of settings with different types of retractors. Preliminary experiences indicate its potential as a cost effective substitute for at least one surgical assistant.

Various Approaches in Total Hip Replacement: Evaluation of Functional Outcome

Various Approaches in Total Hip Replacement: Evaluation of Functional Outcome

The advances and the future of direct anterior approach for total hip replacement

At the meeting of Charlie Yang Rapid Recovery Roadshow (Nanjing Station) in Drum Tower Hospital Affiliated to Medical School of Nanjing University, we were honored to invite Prof. Charlie C. Yang ( Figure 1 ), who serves at the Centura Health Physician Group in Colorado Joint Replacement, to have an interview with us on the advances and the future of direct anterior approach (DAA) for total hip replacement (THA).

THAにおけるanterolateral supine approachと他の前外側アプローチとの比較

THAにおけるanterolateral supine approachと他の前外側アプローチとの比較

The direct anterior minimal invasive approach in total hip replacement: a prospective departmental study on the learning curve.

Introduction of new surgical techniques is normal, but seldom monitored in real time. The purpose of this study was to monitor the learning curve when introducing a new surgical technique to a department. We did a prospective evaluation of the learning curve when introducing the minimally invasive direct anterior approach in total hip arthroplasty. We wish to investigate whether there is a learning curve for the direct anterior minimal invasive approach in total hip replacement and what are the early complications to this approach. The department changed from the direct lateral approach to the minimally invasive direct anterior approach. We monitored the first 522 patients operated using this approach with regards to patient outcome scores and complications 6 months postoperatively. The last 250 patients operated all had significantly better results with regard to patient outcome scores and cup placement. We investigated 100 patients at a time and compared them with the rest of the patient and found the same pattern. This pattern ends when we reach patients somewhere between 200-300. We established the learning curve on a departmental level with regards to introduction of the minimal invasive direct anterior approach. We see a steady improvement in scores with regards to patient outcome scores and cup positioning until we reach a steady-state. The learning curve here flattens out. Departments must understand that one should expect early complications and somewhat less than optimal results at first when introducing this new surgical technique.

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

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.

Anterior Approach in Total Hip Replacement.

In total hip replacement, the anterior approach is intermuscular and internervous and allows the surgeon to reach the capsule without muscle detachment. Advantages include faster recovery and excellent functional outcome as well as reduced postoperative pain and hospital stay. Experienced surgeons currently performing total hip replacement should be aware of all of the difficulties associated with this procedure as well as all of the tricks to overcome the most challenging steps in order to reduce complications during the learning curve. The authors present the most crucial steps in total hip replacement through the anterior approach and describe the potential pitfalls and solutions. [Orthopedics. 2017; 40(3):e553-e556.].