Direct anterior approach total hip arthroplasty with an orthopedic traction table.

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Abstract

[Indexed for MEDLINE] 15. J Am Acad Orthop Surg. 2021 Mar 1;29(5):e217-e231. doi: 10.5435/JAAOS-D-20-00334. Direct Anterior Approach for Revision Total Hip Arthroplasty: Anatomy and Surgical Technique. Siddiqi A(1), Alden KJ, Yerasimides JG, Kamath AF. Author information: (1)From the Department of Orthopedics, Cleveland Clinic Foundation, Cleveland, OH (Kamath and Siddiqi), the Hinsdale Orthopaedics, Hinsdale, IL (Alden), and the Norton Orthopedic Institute, Louisville, KY (Yerasimides). There has been increased interest and literature on the efficacy of direct anterior approach (DAA) for total hip arthroplasty (THA). Developments in surgical technique and instrumentation, along with exposure earlier in orthopaedic residency training, may augment the adoption of this approach among practicing orthopaedic surgeons. With the increasing number of primary THA performed through the DAA, understanding the indications and techniques associated with revision THA via the DAA has proved increasingly important. Patient positioning, understanding surgical anatomy and extensile maneuvers, and applying key reconstructive methods are essential for obtaining adequate exposure and fixation. Acetabular exposure can be facilitated through capsular and soft-tissue release, along with extensile approaches to the pelvis and acetabulum. Extensile distal extension can be performed for safe access to the femur, including extended femoral osteotomies. The purpose of this review is to describe indications, surgical anatomy, intraoperative tips, clinical outcomes, and complications after DAA for revision THA. Copyright © 2021 by the American Academy of Orthopaedic Surgeons. DOI: 10.5435/JAAOS-D-20-00334