Direct Anterior Approach: Risk Factor for Early Femoral Failure of Cementless Total Hip Arthroplasty A Multicenter Study

@article{Meneghini2017DirectAA,
  title={Direct Anterior Approach: Risk Factor for Early Femoral Failure of Cementless Total Hip Arthroplasty A Multicenter Study},
  author={R. Michael Meneghini and Addison S. Elston and Antonia F. Chen and Michael M. Kheir and Thomas K. Fehring and Bryan D Springer},
  journal={The Journal of Bone and Joint Surgery},
  year={2017},
  volume={99},
  pages={99–105}
}
Background: The direct anterior approach for total hip arthroplasty (THA) is marketed with claims of superiority over other approaches. Femoral exposure can be technically challenging and potentially lead to early failure. We examined whether surgical approach is associated with early THA failure. Methods: A retrospective review of 478 consecutive early revision THAs performed within 5 years after the primary THAs at 3 academic centers from 2011 through 2014 was carried out. Exclusion criteria… 
Early Failure of Primary Total Hip Arthroplasty: Is Surgical Approach a Risk Factor?
TLDR
The DAA had aHigher incidence of femoral loosening while PA had a higher mode of failure due to instability, and overall revision rates were not statistically different between approaches.
Risk Factors for Periprosthetic Femoral Fracture in Non-cemented Total Hip Arthroplasty Through the Direct Anterior Approach
TLDR
Older age, age over 70 with BMI of less than 25, osteoporosis, and Parkinson disease were associated with increased risk for early postoperative PPFx following DA approach THA.
The Effect of Surgical Approach and Femoral Prosthesis Type on Revision Rates Following Total Hip Arthroplasty: An Analysis of the Most Commonly Utilized Cementless Stems.
TLDR
THAs performed via the anterior approach had higher rates of revision for femoral stem loosening and fracture, with greater variation in outcomes between individual stems.
Impact of Femoral Stem Design on Failure After Anterior Approach Total Hip Arthroplasty.
TLDR
Pain and function improved predictably with a 0.55% rate of femoral loosening at 2-year follow-up in patients who underwent direct anterior total hip arthroplasty for THA.
Mechanical Complications Following Total Hip Arthroplasty Based on Surgical Approach: A Large, Single-Institution Cohort Study.
TLDR
Even with soft tissue repair, instability continues to occur with increased frequency with the PL approach, so a higher risk of femoral failure with DA must also be considered, although the DL approach appears to confer the lowest overall risk of mechanical complications.
Early Rate of Revision of Total Hip Arthroplasty Related to Surgical Approach: An Analysis of 122,345 Primary Total Hip Arthroplasties.
TLDR
There was no difference in the overall early CPR among the surgical approaches, but the anterior approach was associated with a higher rate of early major revisions and femoral complications compared with the posterior and lateral approaches and with a lower rate of dislocation and infection.
A Comparison of Risk of Dislocation and Cause-Specific Revision Between Direct Anterior and Posterior Approach Following Elective Cementless Total Hip Arthroplasty.
TLDR
While the DAA associated with lower risks of dislocation and revision for instability and periprosthetic fracture, it is associated with a higher revision risk for aseptic loosening.
Surgical Approach to Total Hip Arthroplasty Affects the Organism Profile of Early Periprosthetic Joint Infections
TLDR
Direct anterior THA approaches have a greater risk of monomicrobial gram-negative PJI, likely due to the unique microbiome of the inguinal region, while targeted infection prophylaxis may reduce these infections, it is not entirely effective on its own.
Cementless total hip arthroplasty with anatomic-shaped implants. Does the minimal invasive anterolateral technique influence the stem position or subsidence in contrast to the standard lateral approach?
TLDR
The use of a collared cementless stem seems safe and is likely to prevent a relevant subsidence, even more so in Dorr type B femurs, and a potential risk for early aseptic loosening is seen.
The effect of surgical approach on early complications of total hip arthroplasty
TLDR
The complication rates between the 3 main approaches are similar, but individual surgeons should be vigilant for complications unique to their surgical approaches, such as femoral fractures in the anterior approach and dislocations in the posterior approach.
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