# Mid-term results of cemented hip arthroplasties through the direct anterior approach in the lateral decubitus position: a retrospective cohort study

## TL;DR

This study reports on the 7-year outcomes of hip replacements using a specific surgical approach, finding a relatively low survival rate without improvement over time.

## Contribution

The study provides mid-term results of a less common surgical approach for hip arthroplasty and highlights its challenges during adoption.

## Key findings

- The 7-year survival estimate for the hip prostheses was 95.1%.
- Aseptic loosening of the stem was the main reason for revisions.
- No significant improvement in revision rates was observed with growing experience.

## Abstract

Reports show a high complication rate when starting with the Direct Anterior Approach (DAA) in a supine position for hip arthroplasty. The DAA with the patient in lateral decubitus position may avoid this problem because it supposedly provides better visibility, especially on the femoral side. However, this approach did show a rather high complication rate during the adoption of the approach at 1 year follow up in our previous report. We were interested what the overall 7 year survival estimate would be and whether improvement could be seen with growing experience.

A cohort of patients undergoing total hip arthroplasty right from the start of applying the DAA in lateral decubitus position was analysed.

In total 175 hip prostheses (162 patients) were evaluated. The 7-year survival estimate was 95.1%, 95 CI: 91.8–98.4%. In 6 of 8 revisions there was aseptic loosening of the stem. By dividing the cohort into 3 consecutive groups in time we did not see a significantly improving revision rate.

In our experience, the adoption of the direct anterior approach in lateral decubitus position caused a relatively low 7-year survival estimate without an apparent decrease with growing experience, however given the low number of cases further research is needed to investigate the long-term risk of adopting a new approach.