Direct Anterior Approach for Total Hip Arthroplasty: Implant, Instrument, and Approach

The goal of total hip arthroplasty is to restore native biomechanics and function to the diseased joint while preserving the soft tissue envelope and muscular attachments. The direct anterior approach (DAA) for total hip arthroplasty has seen a significant increase in popularity for both surgeon and patient alike, based on the reported ability to access the joint with less insult to the soft tissue and musculature structures about the hip. In light of this popularity, the development of approach-specific implants, instruments, and operating table setup has also accelerated. Decreased tissue damage, shortened hospital stays, and faster recovery with return to function have been described following the DAA. However, concerns have been expressed regarding a steep learning curve and a host of unique approach-specific complications have been described. The goal of this article is to present the surgical technique, implants, and instruments that aid in successful completion of the DAA for hip arthroplasty, while addressing the early outcomes and difficulties associated with this surgical exposure.