Abstract
In general, the literature makes numerous positive claims regarding the direct anterior approach with a fracture table for total hip arthroplasty (THA), including quicker recovery and return to unassisted ambulation, along with reduced soft tissue damage, surgery time, pain, and risk of dislocation with early elimination of hip precautions. The benefits of the direct anterior approach are mostly due from muscle preservation rather than muscle splitting, which occurs with the more traditional approaches. With the use of the muscle-preserving direct anterior approach for THA, there is less muscle damage and earlier return to function, and postoperative precautions are not needed.
The most significant improvements in THA have been allowing patients to be immediately weight bearing as tolerated after THA, incorporating a multimodal pain management protocol, and now using the direct anterior approach. There is a learning curve, and I strongly recommend that people attend cadaver-based learning centers as well as surgeon visitations.
We must always remember the oath we took to “do no harm,” especially when embarking on a new procedure such as the direct anterior approach in THA or any other new procedure or technology. My position in the debate is not whether we should embrace this technique or other new techniques, but rather how they should be introduced.
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