Title : The direct anterior approach to the hip in the lateral position: A New Zealand experience
Abstract:
Background: The Direct Anterior Approach (DAA) for total hip arthroplasty is well established, with long-term outcomes equivalent to other approaches. However, short-term benefits are particularly compelling, including reduced blood loss, less postoperative pain and analgesia, faster recovery, earlier hospital discharge, greater functionality at discharge, fewer restrictions, and lower risks of dislocation and leg-length discrepancy.
Methods: We describe the lateral position modification of the DAA, developed in New Zealand in collaboration with Mathews Orthopaedics. Key features include familiar patient positioning, straightforward intraoperative radiography, an incision away from the lateral femoral cutaneous nerve, and elimination of the need for traction tables or costly specialised equipment. Unlike traditional supine anterior approaches, this technique avoids significant traction, thereby reducing fracture risk, and provides a rapid learning curve for surgeons.
Results: Surgeons experienced in lateral-position arthroplasty benefit from familiar pelvic orientation, which facilitates accurate and intuitive acetabular component positioning. Early adoption across New Zealand has demonstrated excellent clinical outcomes, with reproducible benefits for both patients and surgeons.
Conclusion: The lateral position modification of the DAA maintains the well-documented short-term advantages of the anterior approach while adding practical, safety, and technical benefits. Its uptake in New Zealand highlights its potential as a valuable evolution of hip arthroplasty technique internationally.
