Surgical technique of direct anterior approach for total hip arthroplasty in the lateral decubitus position / 中华骨科杂志

ABSTRACT

The direct anterior approach is an ideal minimally invasive surgical procedure, which exposes the hip joint through an intermuscular and internervous interval. Compared with other approaches, the direct anterior approach for total hip arthroplasty has several advantages, including less postoperative pain, faster functional recovery and higher patient satisfaction. However, the direct anterior approach could be associated with longer learning curve and higher rate of perioperative complications. We converted the operative position from the classic supine to the lateral decubitus position, aiming to inherit the advantages of the direct anterior approach and to overcome the difficulty of exposing the femoral side in the supine position. The degree of extension, external rotation and adduction of the hip joint was significantly increased in the lateral decubitus position compared to those in the supine position, which provided safe reaming of the femoral medullary cavity and precise implantation of the femoral stem. Therefore, the surgeons do not need to change the operating habits of the acetabular side. The reason is that the exposure of acetabulum in the lateral decubitus position is the same as that in familiar posterior approach. Familiarity with the surgical anatomy and understanding the limitations of the anterior hip approach are the key factors for successful execution.