Frame-based Draping Technique for Standard Table Direct Anterior Approach THA: Efficient and Safe?

Area of Science:

• Orthopedic Surgery
• Arthroplasty Techniques
• Surgical Innovation

Background:

• Direct anterior approach (DAA) for total hip arthroplasty (THA) without a traction table demands precise leg manipulation and sterility maintenance.
• A novel frame-based horizontal one-piece drape was developed to enable repeated leg hyperextension during DAA THA while preserving sterility.
• The efficiency and revision risks of this frame-based DAA THA technique on a standard table require evaluation.

Purpose of the Study:

• To compare the setup and surgery times of the frame-based DAA THA technique versus the traditional stockinette-based technique.
• To evaluate if the frame-based DAA THA technique is associated with higher infection or overall revision rates compared to national benchmarks.

Main Methods:

• Retrospective, comparative cohort study evaluating a novel frame-based drape for DAA THA.
• Efficiency assessed by operative setup time and surgery duration in 385 patients using the frame-based technique versus 387 using the stockinette-based technique.
• Safety evaluated by 5-year revision rates (infection and overall) using the Swiss National Joint Registry, comparing 9973 institutional DAA THAs with 88,443 nationwide.

Main Results:

• The frame-based technique showed significantly shorter median setup time (37 vs. 47 minutes) and surgery duration (63 vs. 72 minutes) (p < 0.001).
• Compared to national benchmarks, the frame-based technique had lower 5-year revision rates for periprosthetic joint infection (0.43% vs. 0.94%) and overall revisions (1.34% vs. 3.52%) (p < 0.001).
• The groups were comparable in ASA classification and indication.

Conclusions:

• The frame-based draping technique for DAA THA on a standard table is simple, efficient, and safe.
• This technique shortens setup time and mitigates contamination risk during leg positioning compared to the stockinette-based method.
• The frame-based technique is not associated with increased revision rates, particularly for PJI, when compared to other DAA THA methods.