Direct Anterior Approach for Total Hip Arthroplasty in bony ankylosis of hips - comparison with historical series performed by posterior approach

Introduction

We performed a retrospective study to assess the intraoperative course and postoperative outcome of Direct Anterior Approach (DAA) in supine position for Total Hip Arthroplasty (THA) in bony ankylosis of hips and compare with historical series of THA in bony ankylosis performed by posterior approach.

Methods

Inpatient details with intra and post operative data were retrieved from the service arthroplasty register and medical records. All patients were followed up till a minimum of 2 years post-surgery with x-rays and clinical score.

Results

Twenty-two patients (28 hips), all males (mean age 33.5 years), underwent THA via DAA in 16 unilateral and 6 bilateral hips. There was no opioids requirement beyond 48 h of surgery with mean hospital stay of 3.6 days for both the groups. The Harris Hip Score improved from preoperative 32 to 88.4 at 2 years. All the hips were stable at 2 years with no radiolucencies and/or component migration/position change. Comparison with the historical series (n = 54 & n = 41), revealed no dislocation, no nerve symptoms and no infection in any of the patients in either series.

Discussion & conclusion

Although technically demanding, the preliminary result of THA by DAA in bony ankylosis of hips is promising. Even in this small cohort, the less analgesic requirement, less hospital stay and no incidence of dislocation should be considered as the advantages of DAA when compared to posterior approach.