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Total Hip Replacement: Is the Direct Anterior Approach the Best Option?

x ray diagram of a hip replacementTotal hip replacement is widely considered to be one of the greatest surgical procedures available. The basic principles are very similar: remove the diseased femoral head (top of the thigh bone) and replace it with a cup that goes into the pelvis (acetabulum) and a stem that goes down the shaft of the femur. The stem supports a ball which then rolls around the new cup. The results are very predictable and durable with a low complication rate.

There are several types of approaches for performing a hip replacement. Recently, a great deal of interest has been focused on what is known as the “Direct Anterior Approach”. This approach has been purported to provide easier and quicker recoveries for patients. While this approach is actually over 50 years old, it has only recently been a source of patient interest. Now that it is being performed more commonly (about 20% of THR across the country are done via this approach), there is beginning to be some scientific articles evaluating the efficacy and safety of this approach.

The most recent article evaluating outcomes of the direct anterior approach is from Meneghini et al (JBJS 2017; 99; 99-15) it was published in January 2017 and it states the following: “In summary, data from our series of revision cases demonstrate that the direct anterior approach may be a risk factor for early femoral component failure due to aseptic loosening after THA. While some have reported benefits of early functional recovery after the direct anterior approach, the cumulative data and peer-reviewed literature do not support claims of superiority of this approach for THA”.

The “take home” message from this most recent article is that there are several different approaches that can be performed for THA and the direct anterior approach is one of them. However, at this point, the scientific literature cannot support the claim that the direct anterior approach is superior (and in fact may be inferior) to other approaches.

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