Why the Direct Anterior Approach for THA

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This document discusses the direct anterior approach for total hip arthroplasty. It lists advantages of the direct anterior approach such as increased stability, easier leg length equalization, lower costs by not requiring an operating table, reduced radiation exposure, faster rehabilitation, and lower risk of deep vein thrombosis. The document also discusses the historical background of the direct anterior approach, showing it has been performed since the 1880s. It presents images showing fatty degeneration of muscles and gluteal atrophy after total hip arthroplasty. Finally, it displays graphs comparing outcomes and improvements in quality of life domains between the direct anterior approach and minimally invasive approaches.

Medical University Innsbruck, AustriaMedical University Innsbruck, Austria
ANTHONY S UNGER, MD
PROFESSOR OTHOPAEDIC
SURGERY
GEORGE WASHINGTON
UNIVERSITY

Medical University Innsbruck, AustriaMedical University Innsbruck, Austria
Why the Direct Anterior
Approach for THA

Medical University Innsbruck, AustriaMedical University Innsbruck, Austria
DAA ADVANTAGES-WITHOUT
TABLE
STABILITY ****
LEG LENGTH EQUALIZATION ****
NO TABLE COSTS ***
NO XRAY **
FASTER REHAB **
LESS DVT *

Medical University Innsbruck, AustriaMedical University Innsbruck, Austria
Fatty Degeneration of the Muscle
Source: Pfirrmann CW, Notzli HP, Dora C, Hodler J, Zanetti M. 2005. Abductor tendons and muscles assessed at
MR imaging after total hip arthroplasty in asymptomatic and symptomatic patients. Radiology 235:969-976.

Medical University Innsbruck, AustriaMedical University Innsbruck, Austria
Havlik Angelika Glutealatrophie

Medical University Innsbruck, AustriaMedical University Innsbruck, Austria
Approaches

Medical University Innsbruck, AustriaMedical University Innsbruck, Austria
1. Karl Hüter 1880
2. Smith-Petersen NM. A new supra-
articular subperiosteal approach to the
hip joint. Am J Orthop Surg 15:592
3. Smith-Peterson NM. Approach to and
exposure of the hip joint for mold
arthroplasty. J Bone Joint Surg Am 31:40
4. Wagner H. Surface replacement
arthroplasty of the hip. Clin Orthop
134:102
5. Keggi K. Anterior Approach THA Via
Mini-Incision Technique. Joint Implant
Surgery & Research Foundation
Historical Background of the DAA

Medical University Innsbruck, AustriaMedical University Innsbruck, Austria
Historical Background of the DAA

Medical University Innsbruck, AustriaMedical University Innsbruck, Austria
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Physical functioning
Role physical
Bodily pain
General health
Vitality
Social functioning
Role emotional
Mental health
MISdv t-glut
p < 0.05
16 vs 36
Points
Improvement
Outcomes

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This 55-year-old man has a 10-year history of progressive contracture of both small fingers due to Dupuytren's disease. He underwent needle aponeurotomy (NA), an office procedure that uses local anesthesia to cut the contracted fascia causing finger contracture. Immediately following the procedure on his left hand, his fingers were straightened with a small skin tear. At 3 weeks, the skin tear had healed and further extension was achieved. At 6 months, good extension remained without signs of recurrence. NA is an alternative to surgery for Dupuytren's disease that can provide relief of contractures with minimal discomfort and short recovery time, though recurrence is possible.

AAOS Guidelines Infection Work-Up

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The AAOS guidelines recommend erythrocyte sedimentation rate and C-reactive protein testing for patients assessed for periprosthetic joint infection. For patients with abnormal ESR or CRP results, joint aspiration is recommended to obtain fluid for microbiological culture, cell count, and differential. Nuclear imaging is an option for diagnosis if infection has not been established and revision is not planned. Intraoperative Gram stain should not be used to rule out infection, but frozen sections of peri-implant tissues and multiple cultures during revision are recommended. Antibiotics should not be started before cultures in suspected periprosthetic joint infection cases. A study found the leukocyte esterase test to be highly sensitive and specific for diagnosing joint infection

Present Status of Unicondylar Knee Arthroplasty

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This document discusses unicompartmental knee arthroplasty (UKA). It provides an overview of the history of UKA, reasons for past failure, and improved outcomes with newer implants and techniques. Studies show 10-year survival rates of 80-98% for UKA, though it has a higher revision rate than total knee arthroplasty. Proper patient selection is important, focusing on isolated medial compartment disease. With experience, attention to alignment and technique, UKA can provide patients pain relief and joint preservation comparable to TKA, especially in younger and older patient populations.

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Why the Direct Anterior Approach for THA

1. Medical University Innsbruck, AustriaMedical University Innsbruck, Austria ANTHONY S UNGER, MD PROFESSOR OTHOPAEDIC SURGERY GEORGE WASHINGTON UNIVERSITY

2. Medical University Innsbruck, AustriaMedical University Innsbruck, Austria Why the Direct Anterior Approach for THA

3. Medical University Innsbruck, AustriaMedical University Innsbruck, Austria DAA ADVANTAGES-WITHOUT TABLE STABILITY **** LEG LENGTH EQUALIZATION **** NO TABLE COSTS *** NO XRAY ** FASTER REHAB ** LESS DVT *

4. Medical University Innsbruck, AustriaMedical University Innsbruck, Austria Fatty Degeneration of the Muscle Source: Pfirrmann CW, Notzli HP, Dora C, Hodler J, Zanetti M. 2005. Abductor tendons and muscles assessed at MR imaging after total hip arthroplasty in asymptomatic and symptomatic patients. Radiology 235:969-976.

5. Medical University Innsbruck, AustriaMedical University Innsbruck, Austria Havlik Angelika Glutealatrophie

6. Medical University Innsbruck, AustriaMedical University Innsbruck, Austria Approaches

7. Medical University Innsbruck, AustriaMedical University Innsbruck, Austria 1. Karl Hüter 1880 2. Smith-Petersen NM. A new supra- articular subperiosteal approach to the hip joint. Am J Orthop Surg 15:592 3. Smith-Peterson NM. Approach to and exposure of the hip joint for mold arthroplasty. J Bone Joint Surg Am 31:40 4. Wagner H. Surface replacement arthroplasty of the hip. Clin Orthop 134:102 5. Keggi K. Anterior Approach THA Via Mini-Incision Technique. Joint Implant Surgery & Research Foundation Historical Background of the DAA

8. Medical University Innsbruck, AustriaMedical University Innsbruck, Austria Historical Background of the DAA

9. Medical University Innsbruck, AustriaMedical University Innsbruck, Austria 0 20 40 60 80 100 Physical functioning Role physical Bodily pain General health Vitality Social functioning Role emotional Mental health MISdv t-glut p < 0.05 16 vs 36 Points Improvement Outcomes

10. Medical University Innsbruck, AustriaMedical University Innsbruck, Austria 0 20 40 60 80 100 Physical functioning Role physical Bodily pain General health Vitality Social functioning Role emotional Mental health MISdv t-glut p < 0.05 16 vs 36 Points Improvement Outcomes

Editor's Notes

Fettige Atrophie des M. gluteus med. nur in der symptomatischen Gruppe! Fatty atrohpy of the M. gluteus med. only in the symptomatic group!
The direct anterior approach utilizes the interval between tensor fasciae latae and sartorius as well as the rectus femoris. It is, like the Watson-Jones interval (between tensor and gluteus medius), one of the two truly intermuscular intervals. But unlike the Watson-Jones interval, it is also truly internerval because all the muscles located medially to the interval are supplied by the femoral nerve, and all muscles located laterally are supplied by the superior gluteal nerve.
SF-36 Vergleich MIS DAA gegen Lateral

Why the Direct Anterior Approach for THA

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