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Presenter: Direct-anterior approach for THA yielded greater risk, limited benefit vs anterior approach
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ORLANDO, Fla. — While the popularity of the direct-anterior approach for total hip arthroplasty has recently increased, the interest in this surgical approach has been mainly driven by industry and surgeons for marketing purposes, according to a speaker here.
“The history of medicine is filled with examples where we let eminence trump evidence. I would argue that the direct-anterior approach is the premier example of that over the past decade,” Bryan D. Springer, MD, said at the Current Concepts in Joint Replacement Winter Meeting. “I have no problem with the surgical approach. I think what most surgeons have a problem with is the sensationalism and the overzealous promotion of this approach by industry and surgeons.”
According to early literature, the benefits of the direct-anterior approach include improvement in gait and mobility and pain relief. However, Springer noted these studies compared the direct-anterior approach to the anterolateral approach, an approach considered to be the most invasive and least muscle-sparing, and results lasted no longer than 6 weeks.
Furthermore, numerous studies have not been able to demonstrate lower dislocation rates between the direct-anterior approach and the posterior approach. An example includes a recent registry study from the Michigan Arthroplasty Registry Quality Initiative, which showed no differences in dislocation rates between the direct-anterior and posterior approaches.
“The initial data suggested high rates of instability with the direct-anterior approach, which was probably somewhat relative to the learning curve,” Springer said.
The direct-anterior approach is associated with several concerning factors, including surgeon learning curve, limited functional benefit and increased complications, he said.
“We have seen these concerns in the literature for [adopting] the direct-anterior approach, which I would argue are extremely high complication rates and should give someone pause for adopting this into their practice,” he said.
Other reported complications that raise concerns are ankle fractures and a high incidence of nerve injury, especially damage to the lateral femoral cutaneous nerve. – by Nhu Te
Reference:
Springer B. Paper #5. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 14-17; Orlando, Fla.
Disclosure: Springer reports he is a consultant for ConvaTec and Stryker; is on the advisory board for OsteoRemedies, Pixar Bio and Joint Purification Systems; and receives royalties from Stryker.