Direct Anterior Approach Total Hip Arthroplasty Revisited

In total hip arthroplasty, the advantages of the direct anterior approach (DAA) compared with the direct lateral and posterior approaches include a true intermuscular approach that spares the abductor musculature, protects the soft tissues surrounding the hip, and thus maintains hip joint stability. The disadvantages of the DAA compared with the direct lateral and posterior approaches include a steep learning curve; intraoperative radiation exposure; injury to the nerves, vessels, and muscles; and intraoperative and early postoperative complications including blood loss, wound-healing problems, increased time under anesthesia, proximal femoral fractures and dislocations, complex femoral exposure and bone preparation, and sagittal malalignment of the stem leading to loosening and an increased revision rate. Stem implantation in flexed sagittal position and early femoral-stem failures are more common with the DAA compared with the direct lateral and posterior approaches.