Published online Apr 18, 2022. doi: 10.5312/wjo.v13.i4.388
Peer-review started: June 26, 2021
First decision: October 18, 2021
Revised: October 31, 2021
Accepted: March 25, 2022
Article in press: March 25, 2022
Published online: April 18, 2022
The direct anterior approach for total hip arthroplasty (DAA-THA) is increasing in popularity due to some advantages such as less surgical trauma, minimal dissection of soft tissues, shorter rehabilitation times, faster return to daily activities, lower incidence of dislocation with different reports in the published papers.
Some literature reports a high rate of perioperative complications, with many different rates and complication types among the published papers without reaching a clear consensus.
Objectives of our study are to analyze our complications and comparing results with the literature reports and to report measures that we have taken to reduce complications rate.
We retrospectively collected data of all DAA-THA patients with one year minimum follow up who were operated at a single high-volume centre, between January 2010 and December 2019. All surgeries were performed using cementless short anatomical or straight stems and press fit cups. Patients’ follow-up was performed with clinical and radiological evaluation. Primary outcomes were stem revision for aseptic loosening and all-cause stem revision. Second outcome was intra-operative and post-operative complications identification.
The authors collected 394 patients underwent DDA-THA from January 2010 and December 2019, for a total of 412 hips; twelve patients lost to follow-up and one patient who died from causes not related to surgery were excluded from the study. Mean follow-up time was 64.8 mo (range 12–120 mo). Seven stems were revised. One cortical perforation, one trochanteric and lateral cortical wall intraoperative fracture, one diaphyseal fracture, three clinically symptomatic early subsidence and one late aseptic loosening. We also observed 3 periprosthetic fractures B1 according to the Vancouver Classification. Other minor complications not requiring stem revision were 5 undisplaced fractures of the calcar region treated with preventive cerclage, one early infection, one case of late posterior dislocation, 18 case of asymptomatic stem subsidence, 6 cases of lateral cutaneous femoral nerve dysesthesia.
In our experience DAA is associated to good outcomes and lower incidence of dislocation. According to our results complication rate can be reduced by mindful patient selection, thorough preoperative planning, sufficient learning curve and use of intraoperative imaging.
Despite these good results, the choice of the ideal surgical approach of THA is still controversial and studies on larger samples are needed.