Peer-review started: June 2, 2015
First decision: September 29, 2015
Revised: October 25, 2015
Accepted: December 3, 2015
Article in press: December 4, 2015
Published online: February 18, 2016
Direct anterior total hip arthroplasty has become increasingly more popular among arthroplasty surgeons, in large part due to the use of an intramuscular interval and desire to reduce soft tissue damage. Several studies have now been published comparing the anterior intramuscular to other commonly used approaches, and many studies have published complication rates on large series of patients. Review of comparative studies indicates direct anterior hips tend towards shorter hospital stays and high rates of patients discharged to home. Although some studies show evidence of early benefit in functional outcomes, there is no strong evidence that the anterior approach provides any long term functional improvements compared to other approaches. Additionally, evidence to support reduced damage to soft tissue may not translate to certain clinical significance. Rates of intra-operative femur fracture, operative time and blood loss rates are notably higher for those developing familiarity with this approach. However, when surgeons have performed a modest number of procedures, the complication rates tend to markedly decrease in most studies to levels comparable to other approaches. Accuracy of component positioning also favors the anterior approach in some studies. This review summarizes the available literature comparing the direct anterior to other approaches for total hip arthroplasty and provides a comprehensive summary of common complications.
Core tip: Direct anterior total hip arthroplasty may provide higher rates of patients discharged to home and shorter hospital stays when compared to other approaches. Long term functional outcomes do not appear to be improved by an intramuscular approach. Complication rates may be high during the initial learning period of performing this approach; however, these rates are generally shown to not exceed that of other approaches once a surgeon has completed a modest number of cases.