First experiences with the direct anterior approach in lateral decubitus position: learning curve and 1 year complication rate

The direct anterior approach (DAA) in supine position for hip arthroplasty has been reported to suffer from high complication rates initially. The DAA with the patient in lateral decubitus position is believed to provide better visibility and especially femoral accessibility with potential fewer complications. The first cohort of total hip prostheses, which were implanted by a single surgeon using DAA in lateral decubitus position more than 1 year ago, was analysed retrospectively. In total 182 hip prostheses (172 patients) were analysed. Three consecutive time periods based on equal number of surgical procedures were compared. The technical complication rate and operating time improved significantly between the 3 consecutive groups. The 1 year infection rate was 0.5% and survival rate of 98.9%. This is the first series of patients that were subjected to a hip replacement based on the direct anterior approach in a lateral decubitus position in which decreasing complication rates suggest the presence of a learning curve in surgeons conducting this type of surgery. Initial complication rate was high but decreased significantly in time and was acceptable certainly in the third group of our cohort. An unacceptable complication rate with the straight uncemented stem forced us to discontinue this configuration after only 7 surgical procedures. Complication, infection and revision rates were acceptable for the all cemented hip replacements using a curved anatomical stem.