Direct Anterior Total Hip Arthroplasty

INTRODUCTION: In theory, the direct anterior approach offers the only path to performing minimally invasive total hip arthroplasty in an intermuscular, internervous plane. STEP 1 POSITION AND DRAPE PATIENT: Careful positioning is necessary to complete this procedure on a standard operating room table. STEP 2 SUPERFICIAL EXPOSURE: Incise the fascia overlying the tensor fasciae latae and lift up the anterior edge, avoiding the perforating vessels. STEP 3 DEEP EXPOSURE: The hip is flexed 30° during the deep dissection. STEP 4 PREPARE ACETABULUM AND IMPLANT ACETABULAR COMPONENT: Ream the acetabulum in 10° to 15° of anteversion with an abduction angle of 40° to 45°. STEP 5 PREPARE FEMUR AND IMPLANT FEMORAL COMPONENT: Use offset broaches to access the femur and prevent perforation through the greater trochanter. STEP 6 TRIAL AND CLOSE: Specifically check for impingement of bone on the implant with the hip flexed 90°. RESULTS: This approach has been used successfully for total hip arthroplasty for decades. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.