Direct anterior approach for total hip arthroplasty in the lateral decubitus position: our experiences and early results

• Published in: The Journal of arthroplasty 2017-01, Vol.32 (1), p.131-138
• Main Authors: Chen, Min, Luo, Zheng-Liang, Ji, Xiao-Feng, Cheng, Peng, Tang, Guo-Lin, Shang, Xi-Fu
• Format: Article
• Language: English
• Subjects: Acetabulum - surgery; Adult; Aged; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - methods; direct anterior approach; dislocation; Feasibility Studies; Female; Femur - surgery; Humans; Joint Dislocations - etiology; lateral cutaneous femoral nerve; lateral decubitus position; Male; Middle Aged; Operating Tables; Orthopedics; Patient Positioning; Postoperative Period; Prospective Studies; Radiography; total hip arthroplasty
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2016.05.066

Abstract Background The direct anterior approach (DAA) for total hip arthroplasty (THA) is typically performed in the supine position using a specially designed operating room table, which makes this approach more accessible to orthopaedic surgeons. We attempted to perform this procedure in the lateral decubitus position on an ordinary operation table to avoid dependence on a special operating room table. There is an obvious absence of literature regarding this subject. Methods 248 patients (295 hips) were recruited for primary THAs from July 1, 2014 to December 31, 2014. In total, 126 hips (42.7%) underwent THAs using the DAA in the lateral decubitus position. The technical feasibility and early results were evaluated. Results The orientation of the acetabular component was 16.5°±4.9° anteversion and 43.3°± 3.5° abduction. Intraoperative proximal femoral fracture occurred in one hip. The superficial wound complications occurred in two hips and the hematoma in one hip while in hospital. The LFCN injury was noted in 43 hips. The early dislocation occurred in two hips. Heterotopic ossification was Brooker class I in five hips and class II in one hip. No aseptic loosening, postoperative periprosthetic fracture and deep infection occurred in our series. Conclusion The DAA for THA in the lateral decubitus position may be a valuable alternative if the DAA in the supine position is difficult to implement owing to absence of a special operating room table. This technique also seems to provide satisfactory clinical and radiographic outcomes with an acceptable complication in our early follow-up.