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Study affirms use of anterior THA, calls for surgeon education
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Investigators are asking surgeons to consider learning the anterior approach for total hip arthroplasty (THA) as an alternative to traditional approaches because it is less invasive and offers comparable early patient outcomes.
“Existing clinical information supports the safety and efficacy of direct anterior THA, particularly in improved early outcomes and enhanced patient and surgeon satisfaction,” Orthopedics Today editorial board member B. Sonny Bal, MD, JD, and colleagues stated in the study. “Surgeon diligence and proper training with cadavers and experienced mentors are necessary to minimize the risk of complications related to learning this technique.”
Bal and colleagues noted that among studies they reviewed that surgery with the anterior approach had a low dislocation rate and early return to function. Additionally, a study comparing the standard direct lateral and direct anterior THA approaches showed increased length of stay and higher blood loss with the direct lateral approach.
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One major complication of direct anterior THA results from the anteriorly placed incision in the thigh: numbness frequently occurred because of the risk in damaging the lateral femoral cutaneous nerve with the anterior approach, the authors stated. They noted a 91% neuropraxia incidence in a hip resurfacing cohort that did not lead to functional impairment.
For revision THA, the researchers recommended the anterior approach. One study they cited documented a 6.6% incidence of early hip dislocation, which is similar to other revision approaches. They also recommended bilateral THA with simultaneous anterior approaches: one series reported 57 patients with bilateral primary THA with an anterior approach and showed no difference in outcomes compared to unilateral cases.
Disclosure: Bal is a consultant for Zimmer, Medtronic, Amedica Corporation and ConforMIS and is on the corporate board for Amedica, OrthoMind and Bonesmart. He is a business partner and founder for the law firm BalBrenner, LLC.
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