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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

In the past decade, the direct anterior approach to total hip arthroplasty has increased in popularity. The approach involves the use of an internervous plane originally described by Smith-Peterson, which allows for easy access to the hip joint through a small incision, even in patients with obesity. The lead author of this video first began performing total hip arthroplasty via the direct anterior approach 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 the use of original illustrations. The goal of this video is to make total hip arthroplasty via the direct anterior approach accessible to orthopaedic surgeons. Special emphasis is placed on setup, draping, incision, dissection, retractor placement, capsule protection, femoral exposure without the use of a traction table, bone preparation, component positioning, prosthesis placement, hip stability, and leg length assessment. The final section of the video is dedicated to the possibility of an accessory incision if femoral exposure is too laborious.

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