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Safety in early experience with a direct anterior approach using fluoroscopic guidance with manual leg control for primary total hip arthroplasty: a consecutive one hundred and twenty case series

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Abstract

Background and purpose

An encouraging result with direct anterior approach (DAA) is attractive for both patients and surgeons. However, the risks associated with beginning to use DAA require further analysis of the learning curve and better countermeasures to ensure safety. We ask whether the complication rate in the DAA by the inexperienced surgeon could be decreased with specific countermeasures. Our hypothesis was that the complication rate would be low even in early phase of the learning curve using the DAA with these particular countermeasures.

Patients and methods

We investigated a consecutive series of 120 primary THA using the DAA with four specific countermeasures; 1) defined exclusion criteria for DAA; 2) no positioning table; 3) use of fluoroscopy as much as required; and 4) having an experienced assistant for DAA (one who has performed the procedure in more than 100 cases). The operative time, the time of fluoroscopic use during the operation, intra and post-operative complications, re-operation for any reason, and cup and stem alignment were investigated.

Results

Although the operation times were similar, the duration of fluoroscopy decreased with surgeons’ experience. There were no intra-operative complications and no re-operations for any reason. One anterior dislocation was observed in one patient. The mean cup inclination and anteversion angle was 39.7° ± 7.6° and 30.3° ± 7.6°; 43.3 % of stems were positioned in flexion, 55.8 % in the neutral position on the lateral view.

Conclusion

We demonstrated a lower complication rate during our early experience with the DAA using four countermeasures. Using these countermeasures for the first 40 cases may be useful for surgeons who are considering DAA.

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Contribution of authors

YH, TB, KK, and TY designed the study. HK, MM, HO, and YO obtained and analyzed the data. YH wrote the initial draft. AD ensured the accuracy of the data and analysis.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, Japan, 113-0033

    Yasuhiro Homma, Tomonori Baba, Hideo Kobayashi, Asuka Desroches, Yu Ozaki, Hironori Ochi, Mikio Matsumoto, Takahito Yuasa & Kazuo Kaneko

  2. Department of Orthopaedic Surgery, Hôpital Henri Mondor, Créteil, France, 94010

    Asuka Desroches

Authors
  1. Yasuhiro Homma
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  2. Tomonori Baba
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  3. Hideo Kobayashi
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  4. Asuka Desroches
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  5. Yu Ozaki
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  6. Hironori Ochi
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  7. Mikio Matsumoto
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  8. Takahito Yuasa
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  9. Kazuo Kaneko
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Corresponding author

Correspondence to Yasuhiro Homma.

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Conflict of interest

No funds were received in support of this study. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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Homma, Y., Baba, T., Kobayashi, H. et al. Safety in early experience with a direct anterior approach using fluoroscopic guidance with manual leg control for primary total hip arthroplasty: a consecutive one hundred and twenty case series. International Orthopaedics (SICOT) 40, 2487–2494 (2016). https://doi.org/10.1007/s00264-016-3159-6

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  • DOI: https://doi.org/10.1007/s00264-016-3159-6

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