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Direct anterior versus small incision lateral approach in total hip arthroplasty: post-operative radiological and
Paola M Zamora-Muñoz1, Angel Cruz-Miranda1, Eira Santiago-Balmaseda1
1Orthopaedics and Trauma Center, ABC Medical Center, Mexico City, Mexico.
Background:
The post-operative position of the acetabular cup and the frequency of complications following total hip arthroplasty (THA) are influenced by the surgical approach. The superiority of the direct anterior approach (DAA) remains uncertain.
Objectives:
The objective of this study was to evaluate the advantages of the DAA compared to the small incision lateral approach (SILA) in primary THA, focusing on radiographic outcomes and complication rate.
Materials And Methods:
Eighty-one patients undergoing THA using either the DAA or SILA were included and followed for 5 years. Acetabular cup placement was assessed using Lewinnek's "safe zone" criteria (abduction [< 40° or ≥ 40°], anteversion [5°-25°]). Documented complications were those frequently reported in the literature.
Results:
The DAA yielded significantly better acetabular cup positioning. (anteversion: OR 9.05, 95% CI 1.91-42.87, p = 0.002; abduction: OR 13.60, 95% CI 3.62-50.97, p < 0.001). Over 5 years, the complication rate was 4.16%, exclusively in the SILA group. Femur fractures occurred more frequently in patients with abduction < 40° (0% [0/46] vs. 11.5% [3/26], p = 0.044).
Conclusion:
The DAA showed superior results in immediate post-operative acetabular cup positioning compared to the SILA. Furthermore, cup abduction angles of < 40° were associated with an increased risk of femur fractures.
