The document discusses the direct anterior approach (DAA) for hip replacement surgery. It notes that DAA results in fewer dislocations, better leg length equalization, and quicker recovery compared to other approaches. The author advocates for DAA due to the reproducible pelvis position, C-arm guidance, and preservation of the posterior capsule which result in precision. Data from the author's experience and studies show lower complication rates and more patients discharged home for DAA versus posterior approaches.

1. ANTHONY S UNGER, MD
WASHINGTON, DC

2. YES
AFFIRMATIVE

3. LESS DISLOCATIONS
BETTER ABILITY TO
EQUALIZE LL
QUICKER RECOVERY

4. POSTERIOR 1-3%
ANTEROLATERAL 1-2%
22-44% of DISLOCATIONS
REQUIRE ADDITIONAL
SURGERY

5. Matta et al---0.61%
Siguier et al----0.96%
Unger 2006-2014 0.3%,
none in last 500 cases

6. WHY???
◦Pelvis is in a reproducible
position when pt is supine
◦DAA—C-arm guidance
◦Preserve posterior capsule

7. Precise with PT
supine—”CAN FEEL
THE MALLEOLI”
X-ray GUIDANCE
OPTION

8.  Kennon/Keggi 2003
 Masonis 2002
 Restrepo 2010
 Berend 2008
 Barrett 2013
 Unger 2006-2014 My
experience—1500 cases

10. Creatine Kinase Differences
between Anterior and Posterior MIS
THA

11. Creatine Kinase Differences
between Anterior and Posterior MIS
THA
5.5X 1.4X 1.8X

12. -200
-100
0
100
200
300
400
CRP IL-6 IL-1B TNF-a
DAA
MPA
Creatine Kinase Differences
between Anterior and Posterior MIS
THA

13. -200
-100
0
100
200
300
400
CRP IL-6 IL-1B TNF-a
DAA
MPA
Creatine Kinase Differences
between Anterior and Posterior MIS
THA

14.  2 DAA SURGEONS and 2
POSTERIOR SURGEONS
 ALL USED SAME
PATHWAY/PROTOCOL
 COMMUNITY HOSPITAL WITH
SNF UNIT
 DATA FROM 2013-2014

15. AA 1 AA 2 PA 1 PA 2
MEAN AGE 70.8 66.6 72.4 69.1
FEMALE 79 16 23 13
MALE 49 7 12 16
MEAN BMI 26.4 27.9 26.9 28.1
%
MEDICARE 71.1 60.9 71.4 62.1
% NON-
MEDICARE 28.9 39.1 28.6 37.9

16. 0
10
20
30
40
50
60
70
80
Ave. age Ave. BMI
POST
POST
POST
POST
DAA
DAA
DAA
DAA
Series1
Series2
Series3
Series4

17. 0
10
20
30
40
50
60
70
80
% Medicare % non-Medicare
post
post
51
DAA
DAA
Series1
Series2
Series3
Series4

18. Procedure LOS (Days)
AA 2.58 ± 0.73
PA 3.43 ± 1.39

19. 0.0
1.0
2.0
3.0
4.0
5.0
6.0
LOS Medicare LOS non-Medicare
DAA<p0.05
2.5
DAA P<0.05
Series1
Series2
Series3
Series4

20. AA 1 AA 2 PA 1 PA 2
TOTAL
SURGERIES 128 23 35 29
COMPLICATION
RATE (%) 7.03 8.70 20.00 13.79

21. 0
10
20
30
40
50
60
70
80
% discharged home
DAA p<.05
Series1
Series2
Series3
Series4

23. 0
1
2
3
4
5
6
7
8
9
1 2 3 4
DAA p <.05
% home in 24 hrs
% home in 24 hrs

24.  DAA
◦ LESS DISLOCATION
◦ MORE PRECISE LL EQUALIZATION
◦ FASTER RECOVERY
 “I ADVOCATE FOR THE DAA HIP
REPLACEMENT”