Complications In Total Hip Replacement in The Beginning of The Learning Curve Using Direct Anterior Approach

Milev R, Stefanov V and Tzachev N

Published on: 2024-09-01

Abstract

Direct anterior approach (DAA) is the most prefered approach to the hip joint performing total hip arthroplasty(THA) in the last decade. It is intramuscular and intranervous approach uses interval superficially between M. tensor fascia lata (innervated by n. gluteus superior) and M. Sartorius (n. femoralis), in depth between m. rectus femoris (n. femoralis) I gluteus medius (n. gluteus superior). Proponents of this approach cite improved recovery times, lower pain levels, improved patient satisfaction as well as improved accuracy on both implant placement/alignment and leg length restoration. A number of variations of the procedure have been described and many authors have published their experiences and technical keys to successfully accomplishing this procedure. Described techniques have been performed using specifically designed instruments and specific fracture tables and intra-operative flouroscopy, however this approach may be performed using a regular table with standard arthroplasty tools with alternative patient positioning and without intraoperative imaging. This review summarizes several aspects of the direct anterior approach for total hip arthroplasty and its comparison to other popular approaches to modern hip replacement. Complications of DAA in THA at the beginning of the learning curve are not an exeption. Our aim is to show all of the complication we had and to prevent as many complications as we can to improve operative technic and surgery outcome in DAA to THA. This can improve surgeon’s learning curve. Complications like iatrogenic injury to the Lateral Femoral Cutaneus Nerve (LCFN), injury to the femoral nerve, postoperative haematoma or active bleading from not ligated(coagulated) Lateral Circumflex Artery (LCA), malposition of the acetabular cup, periprosthetic femur fracture are difficult to treat with slow recovey and may leave the patient not satisfied from the surgery and to discourage surgeon to continue using this approach performing THA.