Techniques for Minimizing Instability in Direct Anterior Approach Total Hip Arthroplasty
As total hip arthroplasty via the direct anterior approach has become more common, knowledge of the technical nuances that allow for more reproducible outcomes has evolved. This video presents our comprehensive approach for minimizing instability during the direct anterior approach for total hip arthroplasty. The goals are to understand a patient’s state of ligamentous laxity, optimize soft-tissue tension through leg length and offset, preserve soft-tissue attachments through patient-specific soft-tissue dissection, optimize cup positioning, and assess stability through provocative testing. The video begins by providing an overview of important preoperative planning considerations. A tailored approach to the capsulotomy and external rotators is then discussed. Recommendations for positioning and sizing of the acetabular component are then reviewed. Finally, our intraoperative stability assessment is demonstrated, and examples of adjustments that can be made to address instability are provided. This video highlights key preoperative considerations and intraoperative techniques to help minimize instability and achieve successful surgical outcomes.