“Table-less” and “Assistant-less” Direct Anterior Approach to Hip Arthroplasty
DOI:
https://doi.org/10.15438/rr.5.3.122Keywords:
Hip arthroplasty, hip replacement, hip reconstruction, direct anterior approachAbstract
In recent years, specialized, non-sterile, traction table systems have facilitated Direct Anterior Approach (DAA) hip arthroplasty. To combat the potential downsides of these traction systems, a sterile, intra-operative retractor option has emerged as a means to access the surgical site more easily, minimize soft-tissue trauma, and reduce the degree of required human assistance. This chapter describes the setup, surgical approach, and early results of a retractor system (the Phantom MIS Anterior Hip Retractor system [TeDan Surgical Innovations, Inc. {TSI}, Houston, Texas, US Patent # 8,808,176 B2]), which uses a standard operating table, allows preparation of both lower extremities free in the surgical field, is compatible with fluoroscopy, and aids in both acetabular and femoral exposure, preparation, and implantation. Early outcome data indicates that this system significantly minimizes the need for surgical assistance, while allowing for safe and effective DAA performance, facilitating the procedure for high-volume surgeons and shortening the learning curve for surgeons new to the procedure.
References
Light TR, Keggi KJ. Anterior approach to hip arthroplasty. Clin Orthop Relat Res. 1980 Oct;(152):255-60.
Kennon RE, Keggi JM, Wetmore RS, Zatorski LE, Huo MH, Keggi KJ.Total hip arthroplasty through a minimally invasive anterior surgical approach. J Bone Joint Surg Am. 2003;85-A Suppl 4:39-48.
Lovell TP. Single-incision direct anterior approach for total hip arthroplasty using a standard operating table. J Arthroplasty. 2008 Oct;23(7 Suppl):64-8.
Berend KR, Lombardi AV Jr, Seng BE, Adams JB. Enhanced early outcomes with the anterior supine intermuscular approach in primary total hip arthroplasty. J Bone Joint Surg Am. 2009 Nov;91 Suppl 6:107-20.
Matsuura M, Ohashi H, Okamoto Y, Inori F, Okajima Y. Elevation of the femur in THA through a direct anterior approach: cadaver and clinical studies. Clin Orthop Relat Res. 2010 Dec;468(12):3201-6.
Seng BE, Berend KR, Ajluni AF, Lombardi AV Jr. Anterior-supine minimally invasive total hip arthroplasty: defining the learning curve. Orthop Clin North Am. 2009 Jul;40(3):343-50.
Masonis J, Thompson C, Odum S. Safe and accurate: learning the direct anterior total hip arthroplasty. Orthopedics. 2008 Dec;31(12 Suppl 2).
Published
How to Cite
Issue
Section
Copyright (c) 2015 Daniel C Allison, Lawrence R Menendez, William W Brien, Timothy McTighe
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and License Agreement:
Authors who publish with the Reconstructive Review agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work. Reconstructive Review follows the Creative Commons Attribution-NonCommercial CC BY-NC. This license allows anyone to download works, build upon the material, and share them with others for non-commercial purposes as long as they credit the senior author, Reconstructive Review, and the Joint Implant Surgery & Research Foundation (JISRF). An example credit would be: "Courtesy of (senior author's name), Reconstructive Review, JISRF, Chagrin Falls, Ohio". While works can be downloaded and shared they cannot be used commercially.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
