Applied Anatomy of the Direct Anterior Approach for Femoral Mobilization

Rodríguez, José A.; Kamara, Eli; Cooper, H. John

doi:10.2106/jbjs.st.16.00099

Cited by 21 publications

(9 citation statements)

References 15 publications

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“…A femoral component was associated with the fracture risk and we would thus recommend for heightened vigilance at the time of surgery to ensure appropriate size. Femoral exposure during AA THA is perceived as the more technically demanding aspect of the procedure, with implants being introduced at a steeper angle into the femoral canal [29,30]. Cementless femoral stems of a shorter design offer an attractive option to counter this problem while permitting soft tissue protection.…”

Section: Discussionmentioning

confidence: 99%

Can We Predict Fracture When Using a Short Cementless Femoral Stem in the Anterior Approach?

McGoldrick

Cochran

Biniam

et al. 2022

The Journal of Arthroplasty

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Section: Discussionmentioning

confidence: 99%

Can We Predict Fracture When Using a Short Cementless Femoral Stem in the Anterior Approach?

McGoldrick

Cochran

Biniam

et al. 2022

The Journal of Arthroplasty

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“…The anterior approach to the hip was performed on a standard operating table with table-mounted retractor to elevate the femur, as previously described. 19 The femur was exposed by dropping the foot of the table and using a table-mounted femoral retractor. The conjoined tendon was at least partially released in all cases.…”

Section: Methodsmentioning

confidence: 99%

Muscle recovery after total hip arthroplasty: prospective MRI comparison of anterior and posterior approaches

et al. 2022

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Introduction: The direct anterior approach (DAA) and the posterior approach (PA) are 2 common total hip arthroplasty (THA) exposures. This prospective study quantitatively compared changes in periarticular muscle volume after DAA and PA THA. Materials: 19 patients undergoing THA were recruited prospectively from the practices of 3 fellowship-trained hip surgeons. Each surgeon performed a single approach, DAA or PA. Enrolled patients underwent a preoperative MRI of the affected hip and two subsequent postoperative MRIs at around 6 weeks and 6 months after surgery. Clinical evaluations were done by Harris Hip Score at each follow-up interval. Results: MRIs or 10 DAA and 9 PA patients were analysed. Groups did not differ significantly with regard to BMI, age, or preoperative muscle volume. 1 DAA patient suffered a periprosthetic fracture and was excluded from the study. DAA hips showed significant atrophy in the obturator internus (−37.3%) muscle at early follow-up, with persistent atrophy of this muscle at the final follow-up. PA hips showed significant atrophy in the obturator internus (−46.8%) and externus (−16.0%), piriformis (−8.12%), and quadratus femoris muscles (−13.1%) at early follow-up, with persistent atrophy of these muscles at final follow-up. Loss of anterior capsular integrity was present at final follow-up in 2/10 DAA hips while loss of posterior capsular integrity was present in 5/9 PA hips. There was no difference in clinical outcomes. Discussion: This study demonstrates that DAA showed less persistent muscular atrophy than PA. Regardless of surgical approach, a muscle whose tendon is detached from its insertion is likely to demonstrate persistent atrophy 6 months following THA. Although the study was not powered to compare clinical outcomes, it should be noted that no significant difference in patient outcomes was observed.

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“…All surgeries were performed through a DA approach [27] using a standard radiolucent operating room table. A table-mounted femoral retractor (Omni-Tract Surgical, St Paul, MN, USA) was used to elevate the femur for canal preparation and femoral component implantation.…”

Section: Methodsmentioning

confidence: 99%

Risk Factors for Periprosthetic Femoral Fracture in Non-cemented Total Hip Arthroplasty Through the Direct Anterior Approach

Berliner

Yau

Jahng

et al. 2021

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: Although total hip arthroplasty (THA) performed through the direct anterior (DA) approach is frequently marketed as superior to other approaches, there are concerns about increased risks of intraoperative and early postoperative femoral fracture. Purpose: We sought to assess patient-specific and radiographic risk factors for intraoperative and early postoperative (90-day) periprosthetic femoral fracture (PPFx) following DA approach THA. Methods: We retrospectively reviewed 1107 consecutive, primary, non-cemented DA THAs, performed between April 2009 and January 2015, for intraoperative and early postoperative PPFx. Patients lost to follow-up before 90 days (63), cemented or hybrid THA (52), or early femoral failure for another indication (3) were excluded, yielding 989 hips for analysis. Demographic variables and patient comorbidities were analyzed as risk factors for PPFx. Continuous variables were initially compared with 1-way analysis of variance (ANOVA) and categorical variables with chi-square test. A demographic matched-paired radiographic analysis was performed for femoral stem canal fill and compared using univariate logistic regression. Results: The incidence of perioperative PPFx was 2.02%, including 10 intraoperative and 10 early postoperative fractures. Sustaining a postoperative PPFx was associated with being 70 years old or older with a body mass index (BMI) of less than 25, or with having either osteoporosis or Parkinson disease. Radiographs demonstrated that intraoperative PPFx was associated with stems that filled greater proximally rather than distally. Conclusion: Our cohort study found older age, age over 70 with BMI of less than 25, osteoporosis, and Parkinson disease were associated with increased risk for early postoperative PPFx following DA approach THA. Intraoperative fractures may occur with disproportionate proximal femoral canal fill. Further study can evaluate whether cemented femoral components may mitigate risk in these patient populations.

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Applied Anatomy of the Direct Anterior Approach for Femoral Mobilization

Cited by 21 publications

References 15 publications

Can We Predict Fracture When Using a Short Cementless Femoral Stem in the Anterior Approach?

Can We Predict Fracture When Using a Short Cementless Femoral Stem in the Anterior Approach?

Muscle recovery after total hip arthroplasty: prospective MRI comparison of anterior and posterior approaches

Risk Factors for Periprosthetic Femoral Fracture in Non-cemented Total Hip Arthroplasty Through the Direct Anterior Approach

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