A 10-year single surgeon series of primary total hip arthroplasty performed through direct anterior approach, and literature review
Keywords:Arthroplasty, Osteoarthritis, Osteoarthritis, Hip, Hip Dislocation
Introduction: The literature review shows improving outcomes of Total Hip Arthroplasty (THA) with Direct Anterior Approach (DA). However, the learning curve and small volume surgeons have been associated with increased complications.
Objectives: The aims were to evaluate outcomes of a single surgeon carrying out primary THA with DAA in selected cases and building up to the routine practice.
Materials & Methods: The data were collected retrospectively from 2009 to 2019 at University Hospital Crosshouse, Kilmarnock. This included demographics, Body Mass Index (BMI), blood transfusion and length of hospital stay. The Oxford Hip Score and general questionnaire were used for functional outcomes. The use of per-operative fluoroscopy during the learning curve and complications experienced were reviewed.
Results: We evaluated 146 consecutive patients who had arthroplasty using DAA from 2009 to 2019. There were 60 female and 86 male patients with a mean age of 57 years (34 to 89 years). Nineteen patient had bilateral hip arthroplasty procedures, and these were simultaneous in seven cases. The procedure was carried out initially in the series in patients with lower BMI (mean 28.4 kg/m2). The follow-up was mean 4.9 years (1.7 to 11.3 years). The mean acetabular abduction angle was 37.5⁰ and an anteversion of 21⁰. The mean leg length discrepancy was 5.8 mm (-11 to 16mm). None of the patients with leg length discrepancy were symptomatic. The Oxford Hip Score improvement of mean 41 points. There were two dislocations (1.3%), one early and the second was late. There were no other major complications.
Conclusion: The current series demonstrates that the DA approach is safe for performing THA. The benefit of this approach is the ability to consistently restore the patients hip joint biomechanical parameters including abduction angle, anteversion and leg length. The complications which are recently highlighted in the literature with learning curve were avoided by using an approach based on careful patient selection, avoidance of higher BMI, use of fluoroscopy per-operatively in the first 25 cases and afterwards in the series only if any doubt on component positioning.