Published online Dec 18, 2022. doi: 10.5312/wjo.v13.i12.1047
Peer-review started: September 13, 2022
First decision: October 28, 2022
Revised: November 9, 2022
Accepted: December 6, 2022
Article in press: December 6, 2022
Published online: December 18, 2022
The direct anterior approach (DAA) for total hip arthroplasty (THA) is a less invasive and muscle-sparing approach that seems to improve early function and patient satisfaction. Several studies, however, have reported high complication and revision rates due to the technical difficulties related to the femoral preparation.
To evaluate the usefulness and safety of a new stem equipped with a morphometric design and a size-specific medial curvature in DAA for THA.
This retrospective study was based on 130 patients that underwent mini-invasive DAA procedures for THA using the Accolade II stem. A total of 144 procedures were included in the assessment, which was based on postoperative complications, survival rates, functional parameters, and patient related outcomes.
Overall complications were recorded in 6 procedures (4.2%). There were no complications related to the stem implantation and no intraoperative fractures. Only one patient was revised for deep infection. On radiographs, biomechanical hip reconstruction was satisfactory and no stem showed any subsidence greater than 2 mm. Full osseointegration based on Engh scores was seen in all of the implanted stems. Median Harris hip score at final follow-up was 99 points (range 44-100 points), which resulted excellent in 91.3% of patients. The median values of the osteaorthritis outcome score ranged from 87.5 to 95.
The mid-term positive outcomes and low complication rate in our consecutive series of patients support the safety and suitability of this new stem design in DAA for THA.
Core Tip: The direct anterior approach can provide a less invasive and muscle-sparing technique for total hip arthroplasty. New stems used in the direct anterior approach have been designed to reduce complication rates, and enhance postoperative morphologic and functional outcomes. The Accolade II stem is equipped with a morphometric design and a size-specific medial curvature, which can be advantageous for this type of surgery.