Total Hip Arthroplasty Surgical Approaches: Optimizing the Outcome

Despite innovation in biomaterials and implant design, surgical approaches for total hip arthroplasty (THA) have remained relatively unchanged since John Charnley's first modern total hip replacement [1]. Currently, the posterior approach (PA) tends to be the most used in the United States [2]. The last two decades have seen a dramatic surge in the prevalence of the direct anterior approach (DAA) worldwide [3]. Nevertheless, the relationship between surgical approach and outcomes has been much debated: in fact, except for the traditional posterior, lateral (LA), and direct anterior surgical approaches to the hip, many other approaches have been proposed to be used in a THA setting. The 2-incision THA, the percutaneously assisted THA, and the superior or northern approach represent innovative proposals. However, it is beyond the scope of this chapter to mention all of them, even in the light of a small body of literature that has been published for many of them. The current international literature lacks evidence on which approach is linked to better outcomes and inferior complications, which might be why different surgical approaches are still used in multiple geographical areas of the globe.