How is direct anterior hip arthroplasty performed?

  Different surgical approaches have their advantages and disadvantages when it comes to intraoperative hip exposure for smooth surgery. The next approach is the direct anterior approach, which is less traumatic to the tissues, has faster postoperative functional recovery, and is comparable to the traditional approach. The traditional posterior-lateral approach damages the vastus lateralis, gluteus maximus, pear muscle and external femoral rotation muscle group, and risks damaging the sciatic nerve, which has a significant impact on the postoperative pain experience and functional recovery of the lower extremity. In contrast, the direct anterior approach utilizes the gap between the broad fascial tensor and sutures muscles to expose the hip joint, and there is basically no incisional damage to the muscles surrounding the approach, resulting in less muscle damage, less postoperative pain, and faster postoperative functional recovery.  Compared with the traditional postero-lateral approach, the advantages of the direct anterior approach are as follows: Although the direct anterior approach has the above-mentioned points compared with the postero-lateral approach, not all hip lesions are suitable for this procedure. 2. Patients with abdominal obesity, especially those with overlapping abdominal tissues and thighs, should not only have difficulty in revealing the anterior approach, but also affect the healing of the incision after surgery; 3. Because the outer plate cannot be removed through this approach, only a small incision can be made to remove the screws.  The risks associated with the direct anterior approach are: damage to the neurovascular bundle (the neurovascular bundle consisting of the femoral artery and nerve is located medial to the suture muscle); damage to the lateral femoral cutaneous nerve; and fracture, which is related to the inherent anatomy of the body and bone quality.  In general, although the above-mentioned surgical risks exist in the direct anterior approach, the advantages of this approach include: 1. minimally invasive surgery, completely transmuscular operation, no damage to the pear-shaped muscle, gluteus medius and other functional muscles of the hip joint; 2. less painful experience in the early postoperative period; faster functional recovery of the lower extremity and early access to the ground; 3. relatively low risk of postoperative dislocation due to less damage to the periarticular muscles and better postoperative gait mechanics 4. Shorter postoperative hospitalization time and reduced hospitalization cost.  These advantages can effectively advance the time of postoperative activities, which has a greater advantage for the prevention of postoperative deep vein thrombosis and pulmonary embolism in the lower limbs, and can effectively shorten the hospitalization time and thus reduce the hospitalization cost.