Tissue Sparing Hip Surgical Approaches

Anterior Path® is an anterior, portal-assisted approach for hip replacement that utilizes a cannula to gain direct access to the acetabulum, offering direct visualization and in-line preparation of the acetabulum and femur.

Anterior Path® Hip Approach

The use of the cannula allows for a transverse incision to be made more superior and lateral, minimizing many challenges related to the femur and wound healing. The placement and orientation of the incision create excellent femoral exposure, alleviate challenges related to femoral preparation, and allow the use of any stem philosophy. The use of a portal to prepare the acetabulum allows direct visualization and in-line reaming and cup impaction.

BROCHURE

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Direct Anterior Wound Complications

The incidence of wound complications is 7 times higher with the use of the Direct Anterior approach, and does not improve with surgeon experience.⁸

Utilizing a Direct Anterior approach Skin incision is not in line with Langer’s lines, which correspond to the natural orientation of collagen fibers in the dermis
Wound is under constant tension
Poor wound perfusion

Anterior® Path Incision Benefits

The Anterior Path® incision is made in line with Langer’s lines and just below the hip crease, providing a number of benefits⁹:

Improved Wound Cosmesis
Improved Wound Healing¹⁰
Fewer Wound Complications

Anterior Path® & the Lateral Femoral Cutaneous Nerve

Retraction required by the Direct Anterior approach to gain access to the hip has led to injury of the LFCN, which results in tingling, numbness and burning pain in the patient’s thigh. Due to the change in the location and orientation of the incision in Anterior Path®, the Lateral Femoral Cutaneous Nerve (LFCN) is more easily avoided. A study on DA showed that a transverse incision reduced subsequent anterior thigh numbness by nearly half.⁹

A comparative study of Direct Anterior shows that in 964 patients there was approximately 1.9 times as much numbness with a longitudinal incision versus a bikini incision.⁹

LEARN MORE ABOUT THE ANTERIOR PATH® PORTAL ASSISTED HIP APPROACH

"So there's always a push for something a little bit different. The beauty of the Anterior Path® is that it makes this surgery better, but it does so without the surgeon having to give up anything that they think is important to them in their surgery."

- Dr. Joseph Assini MD, Englewood, CO

With the Anterior Path® approach, the orientation of the incision is oblique v. longitudinal. Additionally, this oblique incision is made more superior and lateral. The nature and location of the incision has several benefits, including:

Improved visualization and access for broaching & stem placement
Eliminates the need for double offset broach handles
Minimize femoral complications, potentially including peri-prosthetic fracture
Easier femoral preparation
Supports all stem philosophies

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PRECAUTIONS & DISCLAIMERS

Every patient is different, and individual results will vary. As with any major surgical procedure, there are risks and recovery times. The Direct Anterior surgical technique for hip replacement is effective; however it still provides potential challenges such as: implant, nerve and wound complications; increased surgery time and blood loss. The Anterior Path technique is designed to improve the potential challenges related to implant, nerve, and wound complications.

These surgeons are paid consultants for MicroPort Orthopedics. The opinions expressed are theirs alone and do not necessarily reflect the opinions of MicroPort Orthopedics Inc.

Not all products and options are available in all countries.

References
1. As compared to posterior approach THA. Grammatopoulos G et al. Bone Joint J. 2018 Oct;100-B(10):1280-1288.
2. As compared to posterior approach THA. W P Barrett et al./ J of Arthroplasty 28 (2013) 1634-1638.
3. As compared to posterior approach THA. M J Taunton et al. / J Arthroplasty 29 Suppl. 2 (2014) 169-172.
4. As compared to posterior approach THA. Taunton MJ et al. Clin Orthop Relat Res. 2018.
5. Spaans AJ, van den Hout JA, Bolder SB. High complication rate in the early experience of minimally invasive total hip arthroplasty by the direct anterior approach. Acta Orthop 2012;83:342-6.
6. Hartford JM, Knowles SB. Risk Factors for Perioperative Femoral Fractures: Cementless Femoral Implants and the Direct Anterior Approach Using a Fracture Table. J Arthroplasty 2016;31:2013-8
7. Christensen CP, Karthikeyan T, Jacobs CA. Greater prevalence of wound complications requiring reoperation with direct anterior approach total hip arthroplasty. J Arthroplasty 2014;29:1839-41
8. Christensen CP, Jacobs CA. Comparison of Patient Function during the First Six Weeks after Direct Anterior or Posterior Total Hip Arthroplasty (THA): A Randomized Study. J Arthroplasty 2015;30:94–97
9. Leunig et al. Skin crease ‘bikini’ incision for the direct anterior approach in total hip arthroplasty. The Bone & Joint Journal Vol. 100-B, No. 7. 28 Jun 2018
10. Statistically significant for obese patients. Manrique J, Paskey T, Tarabichi M, Restrepo C, Foltz C, Hozack WJ. Total Hip Arthroplasty Through the Direct Anterior Approach Using a Bikini Incision Can Be Safely Performed in Obese Patients. J Arthroplasty. 2019 Aug;34(8):1723-1730

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Tissue Sparing Hip Surgical Approaches

Anterior Path® Hip Approach

Direct Anterior Wound Complications

Anterior® Path Incision Benefits

Anterior Path® & the Lateral Femoral Cutaneous Nerve

LEARN MORE ABOUT THE ANTERIOR PATH® PORTAL ASSISTED HIP APPROACH

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