Are Surgeons Downplaying the Risks of the Direct Anterior Approach?

Unpacking the survey results of 1,855 surgeon websites to understand how the DAA is being sold to patients.

Total hip arthroplasty (THA) is one of the most successful surgical procedures in orthopedics, allowing patients with intractable pain and functional disability to return to higher levels of activity and experience an improved quality of life. In an era of decreasing reimbursement and bundled payments, surgeons and hospital systems are increasingly motivated to search for techniques to further reduce recovery time, postoperative pain, and hospital stay, while maintaining the excellent outcomes and safety profile of traditional methods.

The direct anterior approach (DAA) to THA has garnered significant attention in part due to claims that the approach is associated with less muscle damage and pain as well as accelerated recovery after hip arthroplasty. Although there has been a surge in popularity and widespread adoption and promotion of DAA THA by surgeons, hospitals, and industry, there are few studies that establish long-term clinically significant benefits, safety, and efficacy. Despite claims of superiority and significant marketing, several studies have been published raising concerns regarding nerve damage, muscle damage, blood loss, wound problems, femoral failure, and a technical learning curve.