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Total Hip Arthroplasty through the Direct Anterior Approach: A Case Performed with 43 Years of Experience

March 01, 2017

Contributors: Kristaps J Keggi, MD; Stephen Nelson, MD; Stephen Nelson, MD

Over the last decade, the direct anterior approach (DAA) to total hip arthroplasty (THA) has been increasing in popularity. The approach utilizes an inter-nervous plane originally described by Smith-Peterson which allows for easy access to the hip joint through a small incision, even in obese patients. The lead author first began performing THA through the DAA in 1973 and was the first to publish his results in 1980. This video shows the end product of decades of refinement and clarifies each step of the procedure with original illustrations. The goal of the video is to make THA through the DAA accessible for orthopaedic surgeons. Special emphasis is placed on set up, draping, incision, dissection, retractor placement, capsule protection, femoral exposure without a traction table, bone preparation, component positioning, prosthesis placement, hip stability, and leg length assessment. A final section of the video is dedicated to the possibility of an accessory incision if femoral exposure is too laborious.

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