The direct anterior approach to the hip for total hip arthroplasty: a blind guide (with traction table)

Abstract

: The direct anterior approach (DAA) to the hip is gaining popularity worldwide. It has even become an integral part of orthopaedic training programs across the globe. This approach is well known for its long learning curve, which makes it challenging for residents and fellows to master in a short period of time during their rotations to different subspecialties. There is good evidence to support utilising this approach for a total hip arthroplasty (THA) as it affords patients an improvement in early recovery by way of better gait and kinematics compared to traditional approaches. This approach can be used to expedite patient’s recovery with the aim of an early discharge in the form of an outpatient THA. The enhanced recovery program and day case hip arthroplasty using this approach is our standard practice and works perfectly with this muscle sparing approach. The aim of this article is to present a step-by-step guide for this approach for residents and fellows, and can be adopted by any surgeon working in a teaching setting. This is a full description of our institutional anterior approach to the hip that can be used for primary THA as well as revision cases using a dedicated traction table. This approach can be used for treating femoral neck fractures, periprosthetic infections and periprosthetic fractures. Femoral osteotomy for revision cases can be utilised in a similar fashion to other traditional approaches.