Technology-Assisted Direct Anterior Total Hip Arthroplasty: A Narrative Review of Clinical Evidence, Challenges, and the DAMiS Traction Bed

Total hip arthroplasty (THA) is a crucial intervention for managing degenerative hip diseases, with the anterior approach offering potential advantages of reduced postoperative pain and earlier postoperative recovery. Despite significant advantages, the system has several limitations, such as limited surgical exposure and the risk of soft tissue damage, which ultimately affect clinical outcomes. Various technology-assisted strategies have been introduced to address these challenges in anterior THA, aiming to enhance intraoperative stability, surgical precision, and early rehabilitation, among which the Dynamic Adjustable Modular Integrated System (DAMiS) traction bed is a commonly used traction-assisted approach. Recent studies have reported that traction-assisted techniques may be associated with improvements in selected perioperative outcomes, such as complication rates, implant positioning, and early postoperative recovery, although these findings are primarily derived from retrospective studies with heterogeneous designs. Nonetheless, most available studies are limited by single-center, retrospective designs, small sample sizes, and short follow-up durations, and few provide direct comparisons with conventional techniques. This review provides a narrative overview of technology-assisted direct anterior total hip arthroplasty, outlining the clinical applications, benefits, and limitations of various assistive strategies and discussing future directions for their clinical integration. Further high-quality multicenter trials and long-term evaluations are required to validate the clinical utility of technology-assisted approaches and to guide their appropriate adoption in anterior THA.