Abstract
Goals for total hip arthroplasty include acceleration of recovery, optimisation of component placement, minimisation of peri-operative complications, and maximal preservation of surrounding soft tissues. Achieving these goals when combined with appropriate implant design and manufacture can lead to decades of excellent hip function.
With the exception of relatively rapid recovery, which can also be achieved with virtually all modern surgical exposures, the anterior hip approach fails to reliably achieve these goals. Problems with the anterior exposure for total hip arthroplasty are becoming increasingly recognised. Complications with equal or higher incidences than alternative exposures include: 1.) Early wound complications, 2.) Infection, 3.) Intra-operative and post-operative femur fracture, 4.) Greater trochanteric fracture, 5.) Dislocation, 6.) Femoral component loosening, 7.) Poor component placement, 8.) Poor soft tissue balance, 9.) Incisions with poor aesthetics and associated superficial hypaesthesia and dysaesthesia.
These complications may be in part due to: 1.) The anterior and posterior soft tissue releases often necessary to complete the exposure, 2.) Poor ability to anatomically repair the hip joint capsule, 3.) Reduced choices of femoral components with restriction generally to those with less robust fixation, 4.) The poorly extensile nature of the interval, 5.) The need to place the incision in the region of the flexion crease, 6.) The limited ability to assess soft tissue balance and impingement-free range of motion at the time of surgery, 7.) The undue reliance on unvalidated, inaccurate imaging techniques to assess component placement.
While experienced surgeons can achieve excellent results with the anterior (or virtually any other) exposure for total hip arthroplasty, the anterior exposure is by no means close to being a first among equals.
