Surgical Approach

CHAPTER 35 Surgical Approach


Direct Anterior Revision






The main advantage of the direct anterior approach (DAA) is the preservation of muscle structures. This is especially true for the gluteal abductor muscle, which can be kept intact during primary total hip arthroplasty (THA). Whereas revision THA in general tends to be more destructive, the DAA and its extension have the potential to provide the advantage of gluteal muscle preservation also in revision cases.


If the approach is extended proximally along the iliac crest or distally along the lateral femur, the term “direct anterior” certainly refers to the fact that the portion of the approach in the area of the hip joint itself exploits the interval between the tensor fasciae latae (TFL) and the rectus femoris. Nevertheless, the main advantage of this portal, which is keeping the gluteal muscles intact, can still be achieved.


In my experience, the direct anterior portal to the hip seems ideal for cup revisions. Even in severe cases of acetabular destruction, an extension of the approach is hardly necessary to perform a cemented or uncemented reconstruction.


Straight access to the proximal femur can be achieved with this approach if an endofemoral revision is planned. This requires a partial release of the origin of the TFL from the ilium.


If access to the femoral diaphysis is necessary, the nerve supply does not allow anterior access to the femur. The incision has to be extended laterally or a second incision has to be made. Yet gluteal muscle can still be kept intact.




TECHNIQUE



Mar 10, 2016 | Posted by in Reconstructive surgery | Comments Off on Surgical Approach

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