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Anterior Approach for Total Hip Arthroplasty

Anterior Approach for Hip Arthroplasty

The Anterior Approach offers a wide range of patient and hospital benefits: precision, intuitive instrumentation, education and field specialist support.

The Anterior Approach is a tissue-sparing procedure that exposes the hip with one small incision on the front of the joint. The surgeon works between the muscles and tissues without detaching or sectioning the muscles and tendons around the hip joint.

The Anterior Approach, as described by Dr. Joel Matta*, is performed on a Hana® orthopaedic table, which serves to improve access and achieve alignment and positioning of the implants. It is an evolution of the "Hueter" approach, first used in France in 1947 by Dr. Robert Judet. Also known as the "Smith-Petersen" approach, muscles and tendons are separated at the Smith-Petersen interval, rather than cut, resulting in less trauma and more stability.

Early return to function and decline in complications**
A 2009 retrospective study of 1152 Anterior Approach THA patients across nine clinical sites found†1:

  • An acceptable complication profile
  • Early return to function
  • Decline in complications where the surgeon has more than 100 case experience**
  • Low overall dislocation rate of 0.6%; 0.2% (three dislocations) requiring implant revision

    Patients were in the hospital for a mean 3.6 days, with the majority discharged to home. Eighty percent of patients no longer used an assistive device by four days after hospital discharge. Return to function reached plateau by three months.†1


In another study comparing 211 Anterior Approach procedures to 259 Anterolateral procedures, faster functional return was found with the Anterior Approach. At six weeks, 75% of Anterolateral patients were sedentary or semi-sedentary, compared with just 25% of Anterior Approach patients. At one year, 33% of Anterolateral patients were still sedentary or semisedentary, compared with only 5% of Anterior Approach patients††2.

Outcomes measure at 6 weeks

Patient activity capability measured at 6 weeks for anterior approach patients vs. traditional anterolateral patients.

Outcomes measure at 1 year

Patient activity capability measured at 1 year for anterior approach patients vs. traditional anterolateral patients.

Bone Preserving Stem Options support the Anterior Approach
DePuy Synthes Joint Reconstruction offers multiple femoral systems and specialized instrumentation that may be used with the Anterior Approach. The design of the TRI-LOCK® Bone Preservation Stem and CORAIL® Total Hip System support success with the Anterior Approach to THA.

Potential economic and clinical benefits: Reducing THA resource needs

The tissue-sparing Anterior Approach offers hospitals significant saving opportunities:


  • Shorter inpatient stay—estimated average two days less length of stay in hospital
  • Reduced need for rehabilitation and support services and drugs
  • Reduced risk of complications from extended immobility
  • Reduced risk of dislocations
  • Capital and training costs typically recovered in 100 cases or fewer


Improved contribution
In a study conducted at St. Mark's Hospital, Salt Lake City, adopting the Anterior Approach resulted in a dramatic increase in resource utilization and contribution margins per case. St. Mark's reported benefits including3:


  • Seventy two percent increased hip replacement utilization (from an average of 17.2 cases per month to 29.5)
  • Improved contribution margins per case: 49.6% for Anterior Approach vs. 44.3% for traditional THA
  • Shorter OR utilization: 2.5 hours vs. 3.10 for traditional THA
  • Suitable for a wider range of patient types
  • Improved patient outcomes and satisfaction


*Dr. Matta is a consultant for DePuy Orthopaedics, Inc., and receives royalties as the designer of the hana and PROfx® tables which are manufactured by Mizuho OSI.
**Finding not inconsistent with learning curves reported for conventional THA (22-25).
Study was limited by few centers collecting this data earlier than three months. It is possible that even earlier functional gains were realized with this approach.

†† Comparison of functional outcomes after Anterior Approach* (n=211) with Anterolateral (n=259) cases4 Based on a model built in Excel in accordance with the AMCP Format Dossier guidelines 3.0. Uses data from CMS, Premier Alliance and published studies as the source for model assumptions and default values. Using hospital-specific data, the model will calculate the overall capital budget for the transition to Anterior Approach, presented as ROI in first year, cases until break-even, and months until break-even. Ask your DePuy Synthes Company representative

1 Bhandari M, Matta JM, Kreuzer S, Dodgin D. "The Anterior Total Hip Arthroplasty Collaborative (ATHAC) Investigators. Outcomes Following the Single-Incision Anterior Approach to Total Hip Arthroplasty: A Multi-center Observational Study." Orthop Clin N Am 40. 2009;329–342.

2 Bourne MH, Mariani EM. “A Comparison Between Direct Anterior Surgery of the Hip (DASH) and Anterolateral (AL) Surgical Approaches to Total Hip Arthroplasty: Postoperative Outcomes.” Poster Presentation #014, AAOS New Orleans, LA. March 9–13, 2010.

3 A Case Study from St. Mark's Hospital. "Anterior Approach Hip Replacement Surgery Yields Increased Volume and Reduced Resource Utilization. St. Mark's Hospital. 2009." 2009 DePuy Orthopaedics, Inc. Available upon request from DePuy Synthes.

4 Bourne MH, Mariani EM. "A Comparison Between Direct Anterior Surgery of the Hip (DASH) and Anterolateral (AL) Surgical Approaches to Total Hip Arthroplasty: Postoperative Outcomes." Poster Presentation #014, AAOS New Orleans, LA. March 9–13, 2010.



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