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The minimal invasive direct anterior approach in combination with large heads in total hip arthroplasty - is dislocation still a major issue? a case control study

Steffen Hoell1*, Marius Sander2, Georg Gosheger3, Helmut Ahrens3, Ralf Dieckmann1 and Gregor Hauschild3

Author Affiliations

1 Center of arthroplasty and revision arthroplasty, Department of General Orthopedics and Tumor Orthopedics, University Hospital Muenster, 48149 Muenster, Germany

2 University Hospital Muenster, 48149 Muenster, Germany

3 Department of general orthopedics and tumor orthopedics, University Hospital Muenster, 48149 Muenster, Germany

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BMC Musculoskeletal Disorders 2014, 15:80  doi:10.1186/1471-2474-15-80

Published: 12 March 2014



There have been increasing numbers of publications in recent years on minimally invasive surgery (MIS) for total hip arthroplasty (THA), reporting results with the use of different head sizes, tribologic and functional outcomes. This study presents the results and early complication rates after THA using the direct anterior approach (DAA) in combination with head sizes ≥ 36 mm.


A total of 113 patients with THA were included in the study. The Harris Hip Score (HHS) was determined, a radiographic evaluation was carried out, and complications were recorded. The minimum follow-up period was 2 years (means 35 ± 7 months).


The HHS improved from 43.6 (± 12) to 88.2 (± 14; P < 0.01). One early infection occurred, one periprosthetic fracture, and three cases of aseptic stem loosening. No incorrect positioning of the implants was observed, and there were no dislocations.


THA with the minimally invasive DAA in combination with large heads is associated with good to very good functional results in the majority of cases. The complication rates are not increased. The rate of dislocation mainly as an complication of the first two years can be markedly reduced in particular.

Direct anterior approach; Large heads; Minimal invasive surgery; Total hip arthroplasty; Dislocation rate