title: Direct Anterior Approach for Total Hip Arthroplasty in the Lateral Decubitus Position: Our Experiences and Early Results.
abstract: The direct anterior approach (DAA) for total hip arthroplasty (THA) is typically performed in the supine position using a specially designed operating room table, which makes this approach more accessible to orthopedic surgeons. We attempted to perform this procedure in the lateral decubitus position on an ordinary operation table to avoid dependence on a special operating room table. There is an obvious absence of literature regarding this subject.
  
  
  
  A total of 248 patients (295 hips) were recruited for primary THAs from July 1, 2014 to December 31, 2014. In total, 126 hips (42.7%) underwent THAs using the DAA in the lateral decubitus position. The technical feasibility and early results were evaluated.
  
  
  
  The orientation of the acetabular component was 16.5° ± 4.9° anteversion and 43.3° ± 3.5° abduction. Intraoperative proximal femoral fracture occurred in one hip. The superficial wound complications occurred in 2 hips and the hematoma in one hip while in hospital. The lateral femoral cutaneous nerve injury was noted in 43 hips. The early dislocation occurred in 2 hips. Heterotopic ossification was Brooker class I in 5 hips and class II in 1 hip. No aseptic loosening, postoperative periprosthetic fracture, and deep infection occurred in our series.
  
  
  
  The DAA for THA in the lateral decubitus position may be a valuable alternative if the DAA in the supine position is difficult to implement owing to absence of a special operating room table. This technique also seems to provide satisfactory clinical and radiographic outcomes with an acceptable complication in our early follow-up.
authors.affiliation: Department of Orthopaedics, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui Province, China.
authors.forename: Min
authors.initials: M
authors.lastname: Chen
authors.affiliation: Department of Orthopaedics, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui Province, China.
authors.forename: Zhengliang
authors.initials: Z
authors.lastname: Luo
authors.affiliation: Department of Orthopaedics, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui Province, China.
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Ji
authors.affiliation: Department of Orthopaedics, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui Province, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Cheng
authors.affiliation: Department of Orthopaedics, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui Province, China.
authors.forename: Guolin
authors.initials: G
authors.lastname: Tang
authors.affiliation: Department of Orthopaedics, Affiliated Provincial Hospital of Anhui Medical University, Hefei, Anhui Province, China.
authors.forename: Xifu
authors.initials: X
authors.lastname: Shang
mesh_terms: D000077:Acetabulum / Q000601:surgery; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005269:Femur / Q000601:surgery; D006801:Humans; D004204:Joint Dislocations / Q000209:etiology; D008297:Male; D008875:Middle Aged; D058638:Operating Tables; D056888:Patient Positioning; D011184:Postoperative Period; D011446:Prospective Studies; D011859:Radiography
keywords: direct anterior approach; dislocation; lateral cutaneous femoral nerve; lateral decubitus position; total hip arthroplasty