ArticleInternational orthopaedics2020
Transitioning the total hip arthroplasty technique from posterior approach in lateral position to direct anterior approach in supine position-risk factors for acetabular malpositioning and the learning curve.
Article in International orthopaedics, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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14 citing papers in PubMed, 1 synthesis or guideline pooled it, 26 citations in OpenAlex.
- The learning curve for the direct anterior total hip arthroplasty: a systematic review.International orthopaedics · 2021Pooled it
- Factors associated with mechanical complications following primary total hip arthroplasty through a modified direct anterior approach using custom stems.International orthopaedics · 2025Article
- Learning curve and initial outcomes of a novel percutaneously endoscopic-assisted total hip arthroplasty through mini bikini direct anterior approach: an observational cohort study.Journal of orthopaedic surgery and research · 2024Observational
- Regional migratory osteoporosis of the knee: a literature overview.Musculoskeletal surgery · 2023Review
- Image-based robotic-assisted total hip arthroplasty through direct anterior approach allows a better orientation of the acetabular cup and a better restitution of the centre of rotation than a conventional procedure.International orthopaedics · 2023Article
- Article
- Learning Curve of Total Hip Arthroplasty in Direct Anterior Approach without Requiring Corrective Osteotomy for Hip Dysplasia.Orthopaedic surgery · 2022Article
- Compared learning curves of the direct anterior and anterolateral approach for minimally invasive hip replacement.Orthopedic reviews · 2022Article
- Novel Radiographic Indexes for Elbow Stability Assessment: Part B-Preliminary Clinical Study.Indian journal of orthopaedics · 2021Article
- Novel Radiographic Indexes for Elbow Stability Assessment: Part A-Cadaveric Validation.Indian journal of orthopaedics · 2021Article
- Effects of body mass index and range of motion on intraoperative change in pelvic tilt during total hip arthroplasty using the direct anterior approach.BMC musculoskeletal disorders · 2021Article
- Risk factors for femoral fracture in lateral decubitus direct anterior approach total hip arthroplasty using conventional stems: a retrospective analysis.Journal of orthopaedic surgery and research · 2021Article
- Imaging Analysis of Prosthesis Angle after Hip Replacement with Direct Anterior Approach in Lateral Position.Journal of healthcare engineering · 2021Article
- Restoring hip biomechanics during the learning curve of a novice surgeon: Direct anterior approach vs posterior approach.Journal of orthopaedicsArticle
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Authors and funding
6 authors at 5 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeCup positioning is important for optimum hip stability, avoiding component impingement and decreasing both bearing surface wear and revision rate. Transitioning from posterior approach in a lateral position to direct anterior approach (DAA) in a supine presents unique challenges for surgeons. The aim of this study was to examine the learning curve when using standard instrumentation that was not specific to DAA.
methodsA consecutive retrospective series of 537 total hip arthroplasty by DAA from May 2013 to December 2017. Cup positioning was analysed on radiographs and classified whether inside or outside two safe zones (inclination 30-50° and anteversion 10-30°). The demographic data (age, BMI, gender, neck shaft angle (NSA)), surgeon's dominant side and experience were assessed as risk factors.
resultsEighty per cent of cups (n = 426) were in the combined safe zones. Eighty-eight per cent (n = 470) were in appropriate anteversion and 87% (n = 463) abduction. Two factors that were significant were identified: Cups of left hips operated by right-handed surgeons were more anteverted (OR = 4.06) and more vertical (OR = 2.23); females had a higher anteversion of the cup (OR = 2.42). Obesity, age and NSA were not risk factors for cup malposition. There was a spike of cups too horizontal at the beginning of the experience (OR = 3.86), and no learning curve was observed in the other orientations.
conclusionWith our DAA technique using standard instrumentation, there were no risk factors linked to the patient identified for cup malposition. DAA-specific instrumentation is not required to achieve optimum positioning of the cup. Surgeon has to be aware of an excess of abduction at the beginning of his experience and an excess of anteversion and adduction when performing THA on the opposite side of his dominant hand.
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