The Hip Joint renew of the direct anterior approach

By K. Mohan Iyer

Proponents of the direct anterior approach for hip replacement maintain that using an intermuscular plane to access the hip, without detaching any tendons, results in less trauma to the soft tissues and a quicker recovery from the procedure. The approach itself can be suitably modified to a minimally invasive technique using specialized instrumentation, which can benefit patients. Rapid initial recovery from surgery is high on the list of priorities for various healthcare systems, as this could potentially translate into a reduction in the average length of hospital stay for patients and the possibility of performing day-case hip replacement. In addition, it is proposed that the dislocation rate is lower with the direct anterior approach compared to the postero-lateral approach.

In 1981, Dr K. Mohan Iyer devised an approach to the hip joint―the modified posterior approach―with the help and guidance (cadaveric study) of biomedical engineer Dr Martin A. Elloy, who was attached to the University of Liverpool, UK. At that time, there were considerable reports of dislocation of the hip joints on which the conventional posterior approach, described by Moore, was used. Dr Iyer developed this new approach to confer greater stability to the hip joint posteriorly and minimize the incidence of dislocation. He has used the approach in all his surgeries for over 40 years now, and it has also been highly published. This book is a useful addition to the existing literature on the direct anterior approach to the hip joint as it presents the rationale and technical details of the approach and is of value to surgeons who perform surgery on the hip joint.