Review Article
Volume 4 Issue 2 - 2021
Surgical Approaches to the Hip Joint for Total Hip Arthroplasty - An Updated Review
RB Kalia1 and A Kundu2*
1Additional Professor, Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
2Senior Resident, Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
*Corresponding Author: A Kundu, Senior Resident, Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India.
Received: December 24, 2020; Published: January 27, 2021




Abstract

Primary Total hip arthroplasty (THA) remains a common and successful orthopaedic surgical procedure in today’s time. There has been a constant evolution of surgical techniques and implant designing, for patients of end-stage hip arthritis undergoing THAs. The various approaches like the posterior approach (PA), direct lateral approach (DLA) or the direct anterior approach (DAA) for the hip are mostly used during THA. PA remains the most common approach for THA. PA THA to some extent being extensively used among arthroplasty surgeon has showed lesser evidences of intra-operative blood loss and lesser operative time. DLA remains the second most common approach to the hip during THA. Despite enough literature on the varied surgical approaches to hip joint during THA, the debate still continues, and there is no successful conclusion favouring one approach over the other. DAA-THA shows better shortterm functional outcomes, early post-operative recovery, better pain relief, and lesser hospitalization duration when compared to the conventional PA for THA. Increased evidences of LCNT neuropraxia remains a significant disadvantage with DAA although it does not cause any functional derangement amongst these patients. DLA and PA, both are considered not to utilise an inter-muscular interval. While short external rotators and gluteus maximus are released or splitted in PA, Gluteus maximus and medius are released during DLA. Incidence of abductor muscle weakness has been noted to be as high as 4% to 20% with DLA THA. DAA is on the other hand utilises a true inter-muscular plane. Patient selection for this approach remains an important aspect to avoid post-operative wound complications. The use of intra-operative image guidance during prosthesis placement while performing DAA THA may result in better implant positioning and lesser incidences of post-operative dislocations or limb length discrepancies (LLD).

Keywords: Direct Anterior Approach; Total Hip Arthroplasty; Posterior Approach; Direct Lateral Approach

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Citation: RB Kalia and A Kundu. “Surgical Approaches to the Hip Joint for Total Hip Arthroplasty - An Updated Review”. EC Clinical and Medical Case Reports 4.2 (2021): 13-19.

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