Three-dimensional planning-guided total hip arthroplasty through a minimally invasive direct anterior approach. Clinical outcomes at five years' follow-up.
The direct anterior approach is an attractive option for total hip arthroplasty (THA) in order to achieve a quicker rehabilitation. However, this surgical technique presents a longer learning curve and a higher complications rate compared with the standard approach. We investigated whether three-dimensional (3D) planning anticipated the surgical difficulties and helped to achieve a low complications rate with respect to intra-operative complications, dislocation risk and lower limb discrepancy (LLD).



One hundred and fifty-four consecutive patients underwent a primary cementless THA using a direct anterior approach. A 3D planning was performed in order to anticipate the difficulties that may be encountered regarding femur perforation or fracture, dislocation and LLD. All patients were assessed at a mean five years' follow-up.



No false route and no fracture occurred at the time of surgery. All the surgical difficulties were anticipated. A motorised reaming procedure of the femur was required in six patients because of a very dense bone or a narrow femur. A retroverted neck was used in 7 % of patients because of a torsional abnormality and enabled an increase in stability. The real implant sizes were the same as the ones planned in 97 % for the cup, 96 % for the stem and 100 % for the neck. At five years' follow-up, no dislocation occurred, no patient complained about LLD and excellent clinical outcomes were achieved.



This study demonstrates that 3D pre-operative planning-guided THA through a minimally invasive direct anterior approach is a safe and accurate procedure.



Level IV.
Hôpital Pitié Salpêtrière, 47-83 Bd de l'Hôpital, 75013, Paris, France. hedisari@yahoo.fr.|Laboratoire d'imagerie Biomédicale, 15 rue des cordeliers, 75005, Paris, France. hedisari@yahoo.fr.
Elhadi
0000-0003-2634-2466
E
Sariali
Hôpital Pitié Salpêtrière, 47-83 Bd de l'Hôpital, 75013, Paris, France.
Yves
Y
Catonne
Hôpital Pitié Salpêtrière, 47-83 Bd de l'Hôpital, 75013, Paris, France.
Hugues
H
Pascal-Moussellard
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D004204:Joint Dislocations / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
Accuracy; Direct anterior approach; Dislocation; Planning; Three-dimensional