What is the surgical technique for total hip arthroplasty (Total Hip Replacement)?

From the Guidelines

The direct anterior surgical approach is recommended for hip arthroplasty due to its association with less postoperative pain compared to the posterolateral approach, as shown in a meta-analysis by Wang et al. 1. When considering the surgical technique for hip arthroplasty, several factors come into play, including the approach, use of drains, and minimally invasive techniques.

• The use of postoperative drains is not recommended, as studies have shown similar pain scores with or without drains, and one study even reported higher pain scores in patients with a drain 1.
• Comparing different surgical approaches, the direct anterior approach has been associated with lower pain scores on the first postoperative day, although the difference is less than 10-mm on the VAS 1.
• A meta-analysis by Wang et al. 1 confirmed that the direct anterior surgical approach is associated with less postoperative pain than the posterolateral approach, but it is also associated with a longer duration of surgery.
• Minimally invasive approaches have shown improved postoperative pain outcomes in some studies, but they are also associated with a higher risk of surgical complications, including a five-fold higher risk of iatrogenic nerve damage 1. The surgical technique should prioritize the patient's and surgeon's preference, considering the potential benefits and risks of each approach.
• The procedure typically involves patient positioning, incision, dissection through soft tissues, and preparation of the acetabulum and femoral canal.
• The placement of the acetabular and femoral components requires attention to proper version and inclination angles to ensure stability and optimal outcomes.
• Postoperative protocols should include early mobilization, thromboprophylaxis, and progressive weight-bearing to minimize complications and promote recovery.

From the Research

Hip Arthroplasty Surgical Techniques

• Minimally invasive total hip arthroplasty has been shown to be safe and effective in achieving early postoperative improvements in pain and function 2
• The mini-posterior approach appears to be better than the traditional posterior approach for THA in terms of early patient function and acceptance 2
• Correct component positioning has been consistently achieved with small-incision procedures, and short-term results are the same as those of traditional THA 2

Surgical Approaches

• The most common surgical approaches in use in hip arthroplasty are posterior and lateral, with the anterior approach used by a minority of orthopedic surgeons 3
• North American surgeons favor the posterior approach more often than Europeans, while surgeons from other countries have different preferences 3
• The anterior approach is advised because the dissection is entirely within intermuscular planes, and it can be used with virtually any patient 4, 5

Prosthesis Fixation

• Sixty-eight percent of all surgeons routinely use noncemented hip prosthesis, while 16% use cemented and 16% use hybrid fixation 3
• Noncemented fixation is preferred among surgeons from Europe and North America compared to other countries 3
• The debate between the effectiveness of implant types, cemented or cementless, has been ongoing for years, and financial factors must be considered 6

Minimally Invasive Techniques

• Minimally invasive total hip arthroplasty with the anterior approach is a safe and efficacious procedure with proper surgeon training 4
• The MicroHip technique, a minimally invasive procedure using a modified Smith-Peterson approach, can be successfully applied by good surgeons after suitable training 5
• Minimally invasive techniques can reduce hospitalization time, pain, blood loss, and work incapacity compared to traditional THA 5