There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.
From the Research
Anterior Approach Hip Arthroplasty for Avascular Necrosis
- The anterior approach is a safe, reliable, and feasible technique for total hip arthroplasty, permitting optimal soft tissue preservation 1.
- The direct anterior approach (DAA) may be associated with a reduced risk of dislocation, faster recovery, reduced pain, and fewer surgical complications 2.
- However, there is no evidence to date that shows improved long-term outcomes for patients with the DAA compared to other approaches 3.
Considerations for the Patient's Condition
- The patient's history of gout and normal laboratory results do not seem to be directly relevant to the choice of surgical approach for hip arthroplasty.
- The presence of avascular necrosis, marrow edema, stress fractures, and severe labral tear may require a thorough evaluation to determine the best treatment option.
- The DAA may be comparable to other THA approaches, but there is no evidence to date that shows improved long-term outcomes for patients with these specific conditions 3, 2.
Patient Satisfaction and Outcomes
- Patient satisfaction and hip function one year postoperatively were investigated retrospectively in a cohort of patients who underwent hip replacement surgery by DAA, and no difference in hip function was found between the DAA and the posterolateral or direct lateral approach 4.
- A majority of patients subjectively preferred the DAA, with reasons reported being faster recovery, less sleeping disturbance, and earlier mobilization 4.
- Anterior-based approaches for primary THA demonstrated excellent clinical results and low complication rates overall, with no difference in complication rates between the DAA and anterior-based muscle-sparing approaches 5.