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Total Hip Arthroplasty via Direct Anterior Approach: Clinical Considerations and Physiotherapy Management

Sophia Stasi, George Papathanasiou, Paraskevi Frantzeskaki, Michail Sarantis, Dimitrios Tzefronis and George A Macheras

Total hip arthroplasty (THA) is acknowledged to be one of the most successful procedures in the field of orthopaedic surgery. Over the last 15 years, the direct anterior approach (DAA) has generated scientific interest because of its soft-tissue preserving nature. DAA is a minimally invasive surgical technique and the patient is usually discharged from hospital 3 to 4 days after the operation. During the early postoperative period, appropriate physiotherapy aims to restore the mobility of the operated hip. The in-hospital physiotherapy should be continued at home, with certain precautions taken to safeguard soft-tissue repair healing and avoid hip dislocation. Additionally, the bone ingrowth in THA-surfaces (osseointegration) must be taken into account when evaluating the degree of postoperative weight-bearing during gait, as well as the hip-joint loading during postoperative physiotherapeutic exercises. Physiotherapy is also essential for restoring any preoperative deficit in the operated limb’s abductor muscles during the patient’s gradual return to everyday activities. The purpose of this article is to discuss welldocumented postoperative considerations that could be useful for DAA-surgeons and physiotherapists to minimise the risk of postoperative complications and to achieve the best possible functional health outcome for their patients.