The Direct Anterior Approach to Hip Reconstruction

by Bal, B. Sonny; Rubin, Lee E; Keggi, Kristaps

• ISBN13: 9781630910273
• ISBN10: 1630910279
• Edition: 1st
• Format: Hardcover
• Copyright: 2016-06-15
• Publisher: Slack Incorporated

Summary

Orthopedic surgeons have made steady improvements in total hip arthroplasty to improve safety and enhance surgical outcomes for their patients.  As such, surgeons and patients have focused on less invasive surgical methods, at least for the past decade.  This focus has led to an interest in, and to the development of total hip arthroplasty with the direct anterior surgical approach.
 
The Direct Anterior Approach to Hip Reconstruction is a definitive and comprehensive reference text that addresses the above interest.  This resource is designed to help with introductory learning, intermediate technical development, and advanced revision skills using the direct anterior method.
 
Drs. Sonny Bal, Lee Rubin, and Kristaps J. Keggi have joined their unique perspectives, along with those of a renowned group of experts in the expanding world of anterior hip reconstructions surgery to create this reference.  Dr. Keggi was among the first to recognize and leverage the benefits of the direct anterior approach in hip reconstruction; his 40-plus years of experience as a clinician serve as the foundation for the text.  
 
The Direct Anterior Approach to Hip Reconstruction provides a stepwise progression for surgeons to learn how to perform total hip arthroplasty using the direct anterior approach, with detailed chapters and video instruction from an internationally renowned group of expert authors.
 
The chapters are structured to focus on the art of using the direct anterior approach to address a variety of hip pathology, such as femoroaetabular impingment, pediatric operations, revision implant surgery, and others.  The unique applications of the direct anterior approach within the fields of pediatrics, trauma, reconstruction, and tumor surgery are highlighted, along with chapters focused on femoroacetabular impingment, hip preservation surgery, and postoperative rehabilitation protocols designed to improve patient outcomes.
 
The final section of the book reviews the evidence-based outcomes related to direct anterior total hip arthroplasty, addresses the evolving implant design concepts specific to this approach, and outlines directions for educating the next generation of residents and fellows who will continue to develop and refine these techniques. Complementing the written text is a website that provides access to educational videos to further enhance the learning experience.
 
What Is Inside:

• Basic concepts: Surgical hip anatomy, patient selection, and placement of incisions for primary total hip arthroplasty
• Intermediate concepts: Adoption of imaging and navigation technologies, use of traction tables to enhance positioning, and presentation of unique instruments and custom devices that have evolved specifically for the direct anterior approach
• Advanced concepts: Using the direct anterior approach for bearing and liner exchanges, acetabular revisions, and femoral component revisions

 
To date, no other single reference has addressed a comprehensive education for the orthopedic resident, fellow, or surgeon seeking to learn about the direct anterior approach for hip reconstruction.  This resource should be of value to orthopedic surgeons worldwide.

Author Biography

B. Sonny Bal, MD, JD, MBA is an arthroplasty surgeon, who was one of the early adopters of anterior total hip arthroplasty. Dr. Bal has an academic appointment at the University of Missouri in Columbia, Missouri. In addition to clinical work, he is active in materials science research at the Missouri University of Science & Technology at Rolla, Missouri, and heads a silicon nitride ceramic manufacturer located in Salt Lake City, Utah. Dr. Bal is also an attorney and active in medico-legal education and consulting work.
 
Originally from New Jersey, Lee E. Rubin, MD matriculated as an undergraduate Presidential Scholar at Brandeis University, Waltham, Massachusetts and graduated Cum Laude in 2000. He then graduated with Alpha Omega Alpha distinction from the Tufts University School of Medicine, Boston, Massachusetts in 2004. Dr. Rubin completed his orthopedic training at Yale University, New Haven, Connecticut in 2009, followed by an Adult Reconstruction Fellowship focused on the Direct Anterior Approach with Dr. Kristaps J. Keggi and the Keggi Orthopedic Foundation in Connecticut in 2010.
Dr. Rubin is presently affiliated with University Orthopedics, Inc and is an Assistant Professor of Orthopedic Surgery on the faculty of the Warren Alpert Medical School of Brown University in Providence, Rhode Island. He is actively engaged in numerous clinical research projects through The Miriam Hospital’s Total Joint Center, Providence, Rhode Island, and has published over 50 scientific posters, papers, and book chapters. He is a Fellow of the American Academy of Orthopaedic Surgery (AAOS), a Fellow of the American Association of Hip and Knee Surgeons (AAHKS) an active member of the Orthopaedic Research Society (ORS), and is a Faculty Member of the International Congress for Joint Reconstruction (ICJR).

In 2013, Dr. Rubin was selected and awarded as one of the Forty Under 40 in Rhode Island by the Providence Business News. In 2013, he was elected to serve on the Executive Committee of the Rhode Island Orthopedic Society (RIOS), and was invited to serve on the Board of the Yale Orthopaedic Association in 2016. He is an editorial board member and reviewer for a number of prestigious orthopedic journals, is actively involved with the Rhode Island Chapter of the Arthritis Foundation, and was the Chapter’s Medical Honoree at the Providence Walk to Cure Arthritis event in 2015. He lives outside of Providence, Rhode Island with his wife and 2 children.
 
Kristaps J. Keggi, MD, Dr Med (hc) is the Elihu Professor of Orthopaedics and Rehabilitation at the Yale University School of Medicine in New Haven, Connecticut. Dr. Keggi was born in Latvia and arrived in America as a World War II refugee at the age of 15 years. With the exception of 2 years of general surgical training at the “Old” Roosevelt Hospital in New York City and 2 years of military service with the United States Army in Texas and Vietnam (3rd Surgical Hospital, Army, Mobile), Dr. Keggi has been associated with Yale College and Yale University since 1951. First, he attended Yale as an undergraduate and medical student, later trained as a Yale orthopedic resident, and ultimately joined the teaching faculty of the university, a post he holds to the present day.

Dr. Keggi completed his orthopedic training in 1964 and was practicing and teaching orthopedic surgery for more than 5 years when the Charnley Low Friction Arthroplasty was brought to the United States. He was among the first in Connecticut to perform this procedure in its classical transtrochanteric manner. Based on his training with Wayne O. Southwick, MD, who encouraged innovative thinking, he rapidly moved to utilize the less traumatic Direct Anterior Approach. With the help of Terry Light, MD, his resident at the time, he presented the DAA technique for total hip arthroplasty (THA) and published his early results as a Scientific Exhibit at the 1977 Meeting of the AAOS in Las Vegas. Subsequently, in October of 1980, he published the results in Clinical Orthopaedics and Related Research, thereby becoming one of the first American surgeons to publish on the DAA for THA. Continuously since that era, the DAA has been his primary approach for all simple and complex hip arthroplasty procedures.

Over the course of a career spanning over 50 years, Dr. Keggi has improved the lives of thousands of patients, has taught over 150 Yale residents, and has hosted more than 250 international fellows brought to Yale and The Waterbury Hospital from Latvia, Estonia, Lithuania, Russia, Ukraine, Georgia, Belarus, Kazakhstan, Uzbekistan, Tajikistan, Sweden, Germany, and Vietnam. He is the author of numerous publications on total hip surgery, has lectured at multiple meetings and locations, and has visited sites around the world to teach and perform DAA hip replacements.

During his career, Dr. Keggi has received numerous Yale teaching awards, honorary degrees from Universities around the world, and has been honored with the Latvian Order of the Three Stars in 1993, the V Class Order of the Estonian Red Cross in 1999, the Distinguished Service Medal of the Latvian Physicians Association (the second ever awarded) in 2009, and the Silver Medal of Medical Dignity and Service to Russian Medicine in 2012. He was granted honorary memberships in both the Latvian Academy of Science in 1990 and the Russian Academy of Science in 1993. One of his greatest honors was to have received the George H.W. Bush Lifetime of Leadership Award from his alma mater, Yale University, in 2005.
 

Table of Contents

Dedication

Acknowledgments

About the Editors

Contributing Authors

Foreword by Larry Dorr, MD 

Introduction

Section I Basic Direct Anterior Approach Surgical Technique

Chapter 1 Applied Anatomy of the Anterior Hip and Thigh

Blake E. Peterson, MD and Brett D. Crist, MD

Chapter 2 Indications for the Direct Anterior Approach

R. Presley Swann, MD, MS and Christopher E. Pelt, MD

Chapter 3 Managing Single and Multiple Incisions in Direct Anterior Hip Surgery

Scott A. Ritterman, MD; Kristaps J. Keggi, MD, Dr Med (hc); and Lee E. Rubin, MD

Chapter 4 Primary Total Hip Arthroplasty Using the Hana Table

Navid M. Ziran, MD and Joel M. Matta, MD

Chapter 5 Extensile Approach to Anterior Hip Surgery

Blake E. Peterson, MD and Brett D. Crist, MD

Chapter 6 Anterior Supine Intermuscular Total Hip Replacement

Keith R. Berend, MD; Nathan J. Turnbull, MD; Robert E. Howell, MD; and Adolph V. Lombardi Jr, MD, FACS

Chapter 7 Tips and Tricks for Overcoming the Direct Anterior Approach Learning Curve

Benjamin Domb, MD and Timothy Jackson, MD

Section II Intermediate Direct Anterior Approach Techniques

Chapter 8 Understanding the Risks in New Technologies

B. Sonny Bal, MD, JD, MBA and Lawrence Brenner, JD

Chapter 9 Direct Anterior Total Hip Arthroplasty in the Lateral Decubitus Position

Wietse P.R. Melman, MD; Markus C. Michel, MD; and Cees C.P.M. Verheyen, MD, PhD

Chapter 10 Direct Anterior Total Hip Replacement With Leg Positioning

System and Fluoroscopy

Adam M. Freedhand, MD; Preetesh D. Patel, MD; and Eric M. Slotkin, DO

Chapter 11 Computer Navigation and Robotics in Anterior Hip Reconstruction

David Dodgin, MD; E. Matthew Heinrich, MD; and Joseph T. Moskal, MD, FACS

Chapter 12 Transitioning to Direct Anterior Total Hip Replacement

Blake E. Peterson, MD; Joseph Morgan, MD; and B. Sonny Bal, MD, JD, MBA

Chapter 13 Specialized Instruments for the Direct Anterior Approach

Dan Gerscovich, MD; Anthony S. Unger, MD; Evan Smith, MD; Kristaps J. Keggi, MD, Dr Med (hc); and Lee E. Rubin, MD

Chapter 14 Specialized Retraction for Direct Anterior Total Hip Arthroplasty

Daniel C. Allison, MD, MBA and Timothy McTighe, Dr HS (hc)

Section III Advanced Adult Reconstructive Techniques

Chapter 15 Avoiding, Recognizing, and Treating Complications of the Direct Anterior Hip Approach

Mohan S. Tripathi, MD and Stephen Kayiaros, MD

Chapter 16 How to Identify and Correct Technical Errors With the Direct Anterior Approach

Michael P. Ast, MD and Hari P. Bezwada, MD

Chapter 17 Head and Liner Revision Surgery via the Direct Anterior Approach

Scott A. Ritterman, MD; Matthew E. Deren, MD; and Lee E. Rubin, MD

Chapter 18 Simultaneous Bilateral Direct Anterior ApproachTotal Hip Arthroplasty

Stefan Kreuzer, MD, MSc and Amir Pourmoghaddam, PhD

Chapter 19 Acetabular Direct Anterior Approach Revision Surgery

Jonathan Yerasimides, MD

Chapter 20 Anterior Approach Femoral Revision Surgery

Michael Nogler, MD, MA, MSc

Section IV Direct Anterior Approach Across Orthopedic Specialties: Pediatrics

Chapter 21 Direct Anterior Hip Surgery in Pediatric Patients

Jonathan R. Schiller, MD; Philip McClure, MD; and Lee E. Rubin, MD

Chapter 22 Management of Developmental Dysplasia of the Hip With the Bernese Periacetabular Osteotomy

Atul F. Kamath, MD; Reinhold Ganz, MD; and Michael Leunig, MD

Section V Direct Anterior Approach Across Orthopedic Specialties: Sports/Hip Preservation

Chapter 23 Limited Exposure Direct Anterior Approach for Treatment of Femoroacetabular Impingement

Lee E. Rubin, MD; Joseph A. Gil, MD; and Scott A. Ritterman, MD

Chapter 24 Addressing Acetabular and Femoral Lesions in Hip Impingement With the Direct Anterior Approach

Garrett Davis, MD, MBA, MS and Javad Parvizi, MD, FRCS

Section VI Direct Anterior Approach Across Orthopedic Specialties: Trauma

Chapter 25 Management of Acetabular Fractures in the Elderly WithDirect Anterior Hip Surgery

Steve Papp, MD; Wade Gofton, MD; Derek Butterwick, MD; Allan Liew, MD; and Paul E. Beaulé, MD

Section VII Direct Anterior Approach Across Orthopedic Specialties: Adult Reconstruction/Hip Preservation

Chapter 26 Proximal Femur-Preserving Hip Reconstruction With the Direct Anterior Approach

Stefan Kreuzer, MD, MSc and Amir Pourmoghaddam, PhD

Section VIII Direct Anterior Approach Across Orthopedic Specialties: Oncology

Chapter 27 Tumor Reconstruction of Hip and Proximal Femur With the Anterior Approach

Herrick J. Siegel, MD and Daniel C. Allison, MD, MBA

Section IX Direct Anterior Approach Across Orthopedic Specialties: Rehabilitation

Chapter 28 Patient Rehabilitation After Direct Anterior Hip Surgery

Sarvang Dalal, PT, DPT, MSPT, MTC, FAAOMPT and Amir Pourmoghaddam, PhD

Section X Direct Anterior Approach Across Orthopedic Specialties: Anesthesia

Chapter 29 Anesthesia for the Direct Anterior Approach to Total Hip Arthroplasty

Anjali O. Rozario, MD and Stavros G. Memtsoudis, MD, PhD

Section XI Outcomes

Chapter 30 Multi-Center Outcomes

Harman Chaudhry, MD and Mohit Bhandari, MD, PhD, FRCSC

Chapter 31 Current Direct Anterior Approach Outcomes Literature Review

Tim P. Lovell, MD

Chapter 32 Training and Educating Others About Direct Anterior Hip Surgery

John A. Scanelli, MD and Joseph T. Moskal, MD, FACS

Chapter 33 Understanding Short Femoral Stem Design and Application in Direct Anterior

Approach Total Hip Arthroplasty

Timothy McTighe, Dr HS (hc) and Daniel C. Allison, MD, MBA

Section XII Conclusion

Chapter 34 In Closing: The Futureof Direct Anterior Hip Surgery

Lee E. Rubin, MD; B. Sonny Bal, MD, JD, MBA;and Kristaps J. Keggi, MD, Dr Med (hc)

Financial Disclosures

Index