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Direct anterior approach in lateral position achieves superior cup orientation in total hip arthroplasty: a radiological comparative study of two consecutive series

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Abstract

Introduction

Although the advantages of total hip arthroplasty (THA) using the direct anterior approach (DAA) have been well documented, DAA in the supine position is limited by the difficulty in exposing the acetabulum and femur, which may result in implant malpositioning and intra-operative complications. Recent studies have reported that DAA-THA in the lateral position can achieve satisfactory clinical and radiographic outcomes. The aim of this study was to investigate the difference in implant alignment between two patient cohorts that underwent primary THA by DAA and the traditional posterolateral approach (PLA) in the lateral position.

Methods

A total of 208 THAs (110 using DAA and 98 using PLA) were retrospectively analyzed.

Results

The cup anteversion angle was closer to the target anteversion angle, and the accuracy of cup orientation was superior in the DAA group. A total of 82 (74.5%) DAA-THA and 56 (57.1%) PLA-THA cases showed successful inclination and anteversion angles (p = 0.008) of the implant. In addition, 90 (81.8%) DAA-THA and 67 (68.4%) PLA-THA cases had successful anteversion angle (p = 0.024). There was no significant difference between the two groups in terms of successful inclination angle (98 vs. 81, p = 0.181), as well as in the stem alignment in both coronal and sagittal planes.

Conclusion

THA using DAA in the lateral position can achieve superior cup orientation compared to PLA while maintaining the stem alignment.

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Authors and Affiliations

  1. Clinical Medical College, Shandong University, Jinan, Shandong, People’s Republic of China

    Fei Hu

  2. The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People’s Republic of China

    Xifu Shang, Xianzuo Zhang & Min Chen

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  1. Fei Hu
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Correspondence to Xifu Shang.

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The authors declare that they have no conflict of interest.

Ethical approval

This retrospective study was conducted in compliance with the Helsinki Declaration and was approved by Anhui Provincial Hospital review board.

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Informed consent was obtained from all individual participants included in the study.

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Hu, F., Shang, X., Zhang, X. et al. Direct anterior approach in lateral position achieves superior cup orientation in total hip arthroplasty: a radiological comparative study of two consecutive series. International Orthopaedics (SICOT) 44, 453–459 (2020). https://doi.org/10.1007/s00264-019-04461-4

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