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Surgical Approaches for Total Hip Arthroplasty
Vincent M Moretti1, Zachary D Post1
1Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Insights
Total hip arthroplasty (THA) offers multiple surgical approaches, including posterior, direct lateral, and direct anterior. Each has unique benefits and risks, with no single approach proving superior in current research.
Area of Science:
- Orthopedic Surgery
- Surgical Techniques
- Biomedical Engineering
Background:
- Total hip arthroplasty (THA) is a highly successful and frequently requested orthopedic procedure.
- Multiple surgical approaches exist for THA, with posterior, direct lateral, and direct anterior being most prevalent globally.
Purpose of the Study:
- To review the history, techniques, outcomes, and complications of common THA surgical approaches.
- To provide a comparative overview to aid surgeons in approach selection.
Main Methods:
- Literature review focusing on posterior, direct lateral, and direct anterior THA approaches.
- Analysis of historical development, surgical techniques, patient outcomes, and complication rates for each approach.
Main Results:
- Each common THA approach (posterior, direct lateral, direct anterior) has distinct advantages and disadvantages.
- Current high-quality comparative studies are limited, preventing definitive conclusions on superiority.
Conclusions:
- All major THA approaches can be performed safely and effectively.
- Surgeons should select the THA approach based on their individual expertise and comfort level.
- Alternative approaches like anterolateral and direct superior are recognized but less common.
Abstract:
Total hip arthroplasty (THA) has become one of the most reliable and patient-requested surgical interventions in all medicine. The procedure can be performed using a variety of surgical approaches, but the posterior approach, direct lateral approach, and direct anterior approach are by far the most common across the globe. This article highlights the history and technique for each of these common approaches. A review of outcomes and complications for each approach are also provided. Each approach has its own unique advantages and disadvantages, but all can be safely and successful utilized for THA. Strong, convincing, high-quality studies comparing the different approaches are lacking at this time. Surgeons are therefore recommended to choose whichever approach they are most comfortable and experienced using. Though not described here, THA can also be done using the anterolateral approach (also known as the Watson Jones approach) as well as the two-incision approach. In addition, recently, some surgeons are utilizing the so-called direct superior approach for THA. While these approaches are far less commonly utilized, they are recognized as viable alternatives to traditional approaches.
