The direct anterior approach: First among equals-Opposes

The anterior approach is increasingly practiced throughout the United States. Advocates claim it is minimally invasive, tissue friendly with decreased dislocation rates, decreased hospital stay, and improved outcomes. Recent data however, indicates high complication rates; wound problems, fractures, femoral loosening, and dislocation rates similar to other approaches. The superior approach is modeled after an ideal approach to total hip arthroplasty that is tissue-preserving, inexpensive, and reduces complications of other techniques. Features of the superior approach include simple positioning, no dislocation of the femoral head, preservation of abductors, anterior and posterior capsule, and most, if not all of the external rotators.