Advantages and learning curve of direct anterior approach in total hip arthroplasty

doi:10.3969/j.issn.2095-4344.2775

Abstract

Abstract:

BACKGROUND: With the trend of minimally invasive and “rapid rehabilitation” in modern surgery, direct anterior approach is preferred by orthopedic surgeon in recent years.

OBJECTIVE: To review the direct anterior approach’s history, surgical indications, patients’ selection, surgical methods, common complications, surgery advantages and learning curves, to provide ideas for the rapid rehabilitation of hip arthroplasty.

METHODS: PubMed, Wanfang database, and CNKI were retrieved for articles addressing total hip arthroplasty through direct anterior approach published from 1956 to 2020. Key words were minimally invasive, direct anterior approach, total hip arthroplasty, enhanced recovery after surgery, complication, learning curve” in Chinese and English. Finally, 67 articles met the criteria for review.

RESULTS AND CONCLUSION: (1) The direct anterior approach is an ideal minimally invasive surgical path because of it walks in the fascia gap and it is a truly neuromuscular interface with no damage to important muscles and nerve blood vessels. (2) Direct anterior approach has advantages of quicker recovery, less postoperative pain, short hospital stay and high patient satisfaction. However, because most doctors in our country have changed their surgical approach to direct anterior approach, direct anterior approach still has shortages, such as long learning curve and high rate of early complications.

Key words: minimally invasive, direct anterior approach, total hip arthroplasty, enhanced recovery after surgery, complication, learning curve

CLC Number:

Liu Tiansheng, Su Bin. Advantages and learning curve of direct anterior approach in total hip arthroplasty[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(27): 4364-4369.

Figures/Tables 1

References

[1] RACHBAUER F, KAIN MS, LEUNIG M. The history of the anterior approach to the hip. Orthop Clin North Am. 2009;40(3) : 311-320.

[2] JUDET J,JUDET R. The use of an artificial femoral head for arthroplasty of the hip joint. J Bone Joint Surg Br. 1950;32-B(2): 166-173.

[3] CHARNLEY J. Arthroplasty of the hip. A new operation. Lancet. 1961; 1(7187): 1129-1132.

[4] CHECHIK O, KHASHAN M, LADOR R,et al. Surgical approach and prosthesis fixation in hip arthroplasty world-wide. Arch Orthop Trauma Surg. 2013;133(11): 1595-1600.

[5] JUDET J,JUDET R. Anterior Approach in total hip arthroplasty. Presse Med. 1985;14(18):1031-1033.

[6] WAGNER H. Surface replacement arthroplasty of the hip. Clin Orthop Relat Res. 1978;(134):102-130.

[7] LIGHT TR, KEGGI KJ. Anterior approach to hip arthroplasty. Clin Orthop Relat Res. 1980;152(152):255-260.

[8] Workgroup of the American Association of Hip and Knee Surgeons Evidence Based Committee. Obesity and total joint arthroplasty: a literature based review. J Arthroplasty. 2013;28(5):714-721.

[9] CONNOLLY KP, KAMATH AF. Direct anterior total hip arthroplasty: Literature review of variations in surgical technique. World J Orthop. 2016;7(1):38-43.

[10] MOSKAL JT, CAPPS SG, SCANELLI JA. Anterior muscle sparing approach for total hip arthroplasty. World J Orthop.2013;4(1): 12-18.

[11] POST ZD, OROZCO F, DIAZ-LEDEZMA C, et al. Direct Anterior Approach for Total Hip Arthroplasty: Indications, Technique, and Results.J Am Acad Orthop Surg. 2014;22(9):595-603.

[12] MANRIQUE J, CHEN AF, HELLER S, et al. Direct anterior approach for revision total hip arthroplasty. Ann Transl Med. 2014; 2(10):100.

[13] HALLERT O, LI Y, BRISMAR H, et al. The direct anterior approach: initial experience of a minimally invasive technique for total hip arthroplasty. J Orthop Surg Res. 2012; 7:17.

[14] 罗正亮,陈敏,尚希福,等.侧卧位直接前放入路与后外侧入路全髋关节置换临床疗效比较[J].中华医学杂志,2016,96(35):2807-2812.

[15] CHEN M, LUO Z, JI X, et al. Direct anterior approach for total hip arthroplasty in the lateral decubitus position: our experiences andearly results. J Arthroplasty. 2017;32(1):131-138.

[16] HOMMA Y, BABA T, SANO K, et al. Lateral femoral cutaneous nerve injury with the direct anterior approach for total hip arthroplasty. Int Orthop. 2015;33(7):1-7.

[17] 王世栋,邓雪飞,韩卉,等. Hueter 间隙在髋关节前路手术中的应用解剖学观察[J].中国骨与关节外科,2013,6(1):43-46,49.

[18] BARTON C, KIM PR. Complications of the Direct Anterior Approach for Total Hip Arthroplasty. Orthop Clin North Am. 2009;40(3):371-375.

[19] BENDER B,NOGLER M,HOZACK WJ. Direct anterior approach for total hip arthroplasty. Orthop Clin North Am. 2009;40(3):321-328.

[20] ALECCI V,VALENTE M,CRUIL M,et al.Comparison of primary total hip replacements performed with a Direct Anterior Approach versus the standard lateral approach: perioperative findings. Orthop Traumatol. 2011;12(3):123.

[21] ALEXANDER S. Prospective evaluation of the posterior tissue envelope and anterior capsule after anterior total hip arthroplasty. J Arthroplasty. 2019;32(1): 131-137.

[22] LEUNIG M, HUTMACHER JE, RICCIARDI BF, et al. Skin crease 'bikini' incision for the direct anterior approach in total hip arthroplasty: a two- to four-year comparative study in 964 patients. Bone Joint J. 2018;100-B(7):853-861.

[23] HA YC, YOO JJ, LEE YK, et al. Acetabular component positioning using anatomic landmarks of the acetabulum. Clin Orthop Relat Res. 2012;470(12):3515-3523.

[24] MATSUURA M,OHASHI H,OKAMOTO Y,et al. Elevation of the femurin THA through a direct anterior approach: cadaver and clinical studies. Clin Orthop Relat Res. 2010;468(12):3201-3206.

[25] MOSKAL JT,CAPPS SG,SCANELLI JA. Anterior muscle sparing ap-proach for total hip arthroplasty. World J Orthop. 2013;4(1):12.

[26] MCGEE AS, HUNTLEY SR, LITTLEFIELD ZL, et al. Hip external rotation and extension angles for exposure and preparation of the proximal femur in direct anterior total hip arthroplasty: a cadaveric study. J Clin Orthop Trauma. 2020;11 (Suppl 1): S62-S65.

[27] POST ZD, OROZCO F, DIAZ-LEDEZMA C, et al. Direct anterior approach for total hip arthroplasty: indications, technique, and results. J Am Acad Orthop Surg. 2014;22(9):595-603.

[28] 金大地.关于微创人工全髋关节置换术的若干问题[J].中华外科杂志, 2006,44(8):509-511.

[29] LEUNIG M, FAAS M, VON KNOCH F, et al. Skin crease 'bikini' incision for anterior approach total hip arthroplasty: surgical technique and preliminary results. Clin Orthop Relat Res. 2013;471(7):2245-2252.

[30] GROB K, MONAHAN R, GILBEY H, et al. Distal extension of the di-rect anterior approach to the hipposes risk to neurovascular structures: an anatomical study. J Bone Joint Surg Am. 2015;97(2):126-132.

[31] REICHERT JC, VOLKMANN MR, KOPPMAIR M, et al. Comparative retrospective study of the direct anterior and transgluteal approaches for primary total hip arthroplasty. Int Orthop.2015;39(12):2309-2313.

[32] RUDIN D, MANESTAR M, ULLRICH O, et al. The anatomical course of the lateral femoral cutaneous nerve with special attention to the anterior approach to the hip joint. J Bone Joint Surg. 2016;98(6):561-567.

[33] GOULDING K, BEAULÉ PE, KIM PR, et al. Incidence of lateral femoral cutaneous nerve neuropraxia after anterior approach hip arthroplasty. Clin Orthop Relat Res. 2010;468(9):2397-2404.

[34] OZAKI Y, BABA T, HOMMA Y, et al. Preoperative ultrasound to identify distribution of the lateral femoral cutaneous nerve in total hip arthroplasty using the direct anterior approach. SICOT J. 2018;4:42.

[35] HOSHINO C, KOGA D, KOYANO G, et al. Femoral nerve palsy followingprimary total hip arthroplasty with the direct anteriorapproach. PLoS ONE. 2019;14(5):e0217068.

[36] LEE GC, MARCONI D. Complications following direct anterior hipprocedures: costs to bothpatients and surgeons. J Arthroplasty. 2015;30(Suppl 9):98-101.

[37] MAYLE RE. DELLA CJ. Intra-operative fractures during THA: see it before it sees us. J Bone Joint Surg Br. 2012;94(11 SupplA):26-31.

[38] JEWETT BA, COLLIS DK. High complication rate with anterior total hip arthroplasties on a fracture table. Clin Orthop Relat Res. 2011;469(2): 503-507.

[39] GHIJSELINGS SG, DRIESEN R, SIMON JP, et al. Distal extension of the direct anterior approach to the hip: a cadaveric feasibility study. J Arthroplasty. 2017;32(1):300-303.

[40] THALER M, DAMMERER D, KRISMER M, et al. Extension of the direct anterior approach for the treatment of periprosthetic femoral fractures. J Arthroplasty. 2019;34(10):2449-2453.

[41] JAHNG KH, BAS M, RODRIGUEZ JA, et al. Risk factors for wound complications following direct anterior approach hip arthroplasty. J Arthroplasty. 2016. doi: 10.1016/j.arth.2016.04.030.

[42] ANTONIADIS A, DIMITRIOU D, FLURY A, et al. Is direct anterior approach a credible option for severely obese patients undergoing total hip arthroplasty? a matched-control, retrospective, clinical study. J Arthroplasty. 2018. doi: 10.1016/ j.arth.2018.03.071.

[43] MARCONI D, LEE GC. Complications following direct anterior hip procedures: costs to both patients and surgeons. J Arthroplasty. 2015;30(9 Suppl) :98-101.

[44] WANG Z, HOU JZ, WU CH, et al. A systematic review and meta-analysis of direct anterior approach versus posterior approach in total hip arthroplasty. J Orthop Surg Res. 2018;13:229.

[45] BERGIN PF, DOPPELT JD, KEPHART CJ, et al. Comparison of minimally invasive direct anterior versus posterior total hip arthroplasty based on inflammation and muscle damage markers. J Bone Joint Surg Am. 2011;93(15):1392-1398.

[46] BREMER AK, KALBERER F, PFIRRMANN CW, et al. Soft-tissue changes in hip abductor muscles and tendons after total hip replacement: comparison between the direct anterior and the transgluteal approaches. J Bone Joint Surg Br. 2011; 93(7) :886-889.

[47] MIRZA AJ, LOMBARDI AV JR, MORRIS MJ, et al. A mini-anterior approach to the hip for total joint replacement: optimising results: improving hip joint replacement outcomes . Bone Joint J. 2014; 96B(11 Supple A):32-35.

[48] ALECCI V, VALENTE M, CRUCIL M, et al. Comparison of primary total hip replacements performed with a direct anterior versus the standard lateral approach: perioperative findings. J Orthop Traumatol. 2011; 12:123-129.

[49] TAUNTON MJ, MASON JB, ODUM SM, et al. Direct anterior total hip arthroplasty yields more rapid voluntary cessation of all walkingaids: a prospective,randomized clinical trial. J Arthroplasty. 2014;29(9): 169-172.

[50] BARRETT WP, TURNER SE, LEOPOLD JP. Prospective randomized study of direct anterior vsposter-lateral approach for total hip arthroplasty. J Arthroplasty.2013;28(9):1634-1638.

[51] ZAWADSKY MW, PAULUS MC, MURRAY PJ, et al. Early outcome comparison between the direct anterior approach and the mini-incision posterior approach for primary total hip arthroplasty: 150 consecutive cases. J Arthroplasty. 2014;29(6):1256-1260.

[52] KUNKEL ST, SABATINO MJ, KANG R, et al. A systematic review and meta‑analysis of the direct anterior approach for hemiarthroplasty for femoral neck fracture. Eur J Orthop Surg Traumatol. 2018;28:217-232.

[53] NEYISCI C, ERDEM Y, BILEKLI AB, et al. Direct anterior approach versus posterolateral approach for hemiarthroplasty in the treatment of displaced femoral neck fractures in geriatric patients. Med Sci Monit. 2020; 26: e919993.

[54] DEN DAAS A, REITSMA EA, KNOBBEN BAS, et al. Patient satisfaction in different approaches for total hip arthroplasty. Orthop Traumatol Surg Res. 2019;105(7):1277-1282.

[55] JAYANKURA M, POTAZNIK A. Total hip arthroplasty by mini-approach:review of literature and experience of direct anterior approach on orthopaedic table. Rev Med Brux. 2011;32(6 Suppl): S76-S83.

[56] HALLERT O, LI Y, BRISMAR H, et al. The direct anterior approach :initial experience of a minimally　invasive technique for total hip arthroplasty.J Orthop Surg Res. 2012;7:17.　

[57] DEBI R, SLAMOWICZ E, COHEN O, et al. Acetabular cup orientation and postoperative leg length discrepancy in patients undergoing elective total hip arthroplasty via a direct anterior and anterolateral approaches. BMC Musculoskelet Disord. 2018;19:188.

[58] MAFFIULETTI NA, IMPELLIZZERI FM, WIDLER K, et al. Spatiotemporal parameters of gait after total hip replacement: anterior versus posterior approach.Ortho p Clin North Am. 2009;40(3):407-415. 　

[59] NAKATA K, NISHIKAWA M, YAMAMOTO K, et al. A clinical comparative study of the direct anterior with mini-posterior approach: two consecutive series. J Arthroplasty. 2019;24(5):698-704. 　

[60] SIGUIER T, SIGUIER M, BRUMPT B. Mini-incision anterior approachdoes not increase dislocation rate: a study of 1 037 total hip re-placements. Clin Orthop Relat Res. 2004;(426): 164-173.

[61] RESTREPO C, PARVIZI J, POUR AE, et al. Prospective randomized study of two surgical approach for total hip arthroplasty. J Arthroplasty. 2010;25(5):671-679.

[62] LECOANET P, VARGAS M, PALLARO J, et al. Leg length discrepancy after total hip arthroplasty: Can leg length be satisfactorily controlled via anterior approach without a traction table? Evaluation in 56 patients with EOS 3D. Orthop Traumatol Surg Res. 2018;104(8):1143-1148.

[63] WOOLSON ST, POULIOT MA, HUDDLESTON JI. Primary total hip arthroplasty using an anteriorapproach andafracture table:short-term results fromacommunity hospital. J Arthroplasty. 2009;24(7):999-1005.

[64] STONE AH, SIBIA US, ATKINSON R, et al. Evaluation of the learning curve when transitioning from posterolateral to direct anterior hip arthroplasty: a consecutive series of 1000 cases. J Arthroplasty. 2018; 33:2530-2534.

[65] YUASAA T, MAEZAWAA K. Safely transitioning to the direct anterior from posterior approach for total hip arthroplasty. J Orthop. 2018;15: 420-423.

[66] FREE MD, OWEN DH, AGIUS PA, et al. Direct anterior approach total hip arthroplasty: an adjunct to an enhanced recovery pathway: outcomes and learning curve effects in surgeons transitioning from other surgical approaches. J Arthroplasty. 2018;33(11):3490-3495.

[67] PIRRUCCIO K, EVANGELISTA PJ, HAW J, et al. Safely implementing the direct anterior total hip arthroplasty: a methodological approach to minimizing the learning curve. Am Acad Orthop Surg. 2020. doi: 10.5435/JAAOS-D-19-00752.