Does Direct Anterior Approach for Total Hip Replacement Require a HANA Table?
No, the direct anterior approach (DAA) for total hip arthroplasty does NOT require a HANA table or specialized traction table—it can be safely and effectively performed on a standard operating room table.
Evidence Supporting Either Approach
The available research demonstrates that DAA can be successfully performed with either setup:
Standard Operating Room Table
- A 2024 study of 322 patients found no differences in patient-reported outcomes, operative times (87 vs 90 minutes), satisfaction scores, or complication rates between specialized traction tables and regular OR tables 1
- A single-surgeon series of 1,017 primary THAs performed on a regular table without fluoroscopy achieved excellent 2-year results with only 0.3% dislocation rate and 1.5% revision rate 2
- A matched-control study of 150 patients demonstrated that performing DAA without a traction table resulted in significantly more accurate leg length restoration (2.4 ± 2 mm vs. 3.7 ± 3.1 mm) with no increase in complications 3
Specialized Traction Table
- Some surgeons report technical ease and predictability with traction tables 4
- A meta-analysis showed traction table use was associated with longer operative times (100 vs 71 minutes) and increased blood loss (531 vs 382 ml), though outcomes were otherwise equivalent 4
- DAA can even be performed in lateral decubitus position on ordinary tables, demonstrating the approach's versatility 5
Clinical Decision-Making Algorithm
Choose standard OR table when:
- Precise leg length restoration is a priority
- Minimizing operative time is important
- Avoiding traction-related positioning complications is desired
- Cost containment is a consideration
Choose specialized traction table when:
- Surgeon is already experienced with this setup
- Facility has invested in the equipment
- Surgeon prefers the technical ease for femoral exposure
Key Technical Considerations
Regardless of table choice:
- The surgical approach itself (intramuscular/internervous interval) remains identical
- Component positioning accuracy is equivalent between setups
- Complication rates are comparable
- Patient outcomes at 1-2 years show no significant differences
Important Caveat
The choice of table should depend entirely on surgeon experience and preference 6. The guidelines for total hip arthroplasty emphasize that surgical technique should be based on surgeon and patient preference when evidence for postoperative pain outcomes is inconclusive 6. Since morbidity, mortality, and quality of life outcomes are equivalent between table types, surgeons should use whichever setup they are most comfortable with to optimize patient outcomes 1.
The specialized traction table is not a requirement for performing DAA—it is simply one of multiple valid technical options.