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The Direct Anterior Approach to Hip Reconstruction

SECOND EDITION

The Direct Anterior Approach to Hip Reconstruction

SECOND EDITION

Editor-in-Chief Lee E. Rubin, MD, FAAOS, FAAHKS, FAOA Associate Professor of Orthopaedic Surgery Chief, Division of Adult Reconstruction Chief, Yale-New Haven Hospital Total Joint Replacement Program

Program Director, Yale Arthroplasty Fellowship Department of Orthopaedics and Rehabilitation Yale University School of Medicine New Haven, Connecticut

Senior Editors B. Sonny Bal, MD, MBA, JD, PhD Chief Executive Officer & President

Associate Editors H. John Cooper, MD

Associate Professor of Orthopedic Surgery Columbia University Irving Medical Center New York Presbyterian Hospital New York, New York Kristoff Corten, MD, PhD Hip Unit Orthopedic Department Ziekenhuis Oost-Limburg, Genk Associate Professor Department of Rehabilitation Sciences University of Hasselt Hasselt, Belgium Heuppraktijk/European Hip Clinic Herselt, Belgium Park Medisch Centrum Rotterdam, The Netherlands Jeremy M. Gililland, MD, FAAOS, FAAHKS Chief of Orthopaedic Surgery, George E. Whalen VA Medical Center Director of Research for Adult Reconstruction Service Associate Professor of Orthopedic Surgery Division of Adult Reconstruction University of Utah Salt Lake City, Utah Theodore Manson, MD, MS Clinical Professor of Orthopaedic Surgery University of Maryland Baltimore, Maryland

SINTX Technologies Salt Lake City, Utah Joseph T. Moskal, MD, FAAOS, FAAHKS, FAOA, FACS Professor and Chairman Department of Orthopaedic Surgery

Virginia Tech Carilion School of Medicine (VTCSOM) Chief and Fellowship Director, Adult Reconstruction (Hip and Knee) Carilion Clinic and VTCSOM Associate Professor University of Virginia Medical School Associate Professor Edward Via College of Osteopathic Medicine Chairman, Department of Orthopaedic Surgery Carilion Clinic Senior Vice President, Carilion Clinic Roanoke, Virginia Editor Emeritus Kristaps Juris Keggi, MD, Dr Med (hc) (deceased) Professor Emeritus Yale University School of Medicine Department of Orthopaedics and Rehabilitation New Haven, Connecticut

J. Bohannon Mason, MD Adult Reconstructive Surgery

OrthoCarolina Hip and Knee Center Professor of Orthopedic Surgery Atrium Musculoskeletal Institute Charlotte, North Carolina

Acquisitions Editor: Tulie McKay Development Editor: Stacey Sebring Editorial Coordinator: Remington Fernando Marketing Manager: Kirstin Watrud Production Project Manager: Justin Wright Manager, Graphic Arts & Design: Stephen Druding Manufacturing Coordinator: Lisa Bowling Prepress Vendor: TNQ

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ISBN-13: 978-1-975221-97-3

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To our Mentors You have taken significant personal time and effort to guide our individual development as physicians, as orthopaedic surgeons, and as leaders. Thank you, as you have encouraged us to reach our full potential; you have implored us to “press on” and drive the evolution of hip surgery forward through the pursuit of excellence in clinical care closely paired with scientific research. To our Trainees Your tireless work as students, orthopaedic surgery residents, and adult reconstruction fellows is an inspiration to each of us as authors and editors of this text. We recognize and honor the importance of your training and the impact it will have on the future of our profession. We celebrate your bright future with this work, which we hope will elevate each of you and be an enduring guide for the future. To our Families For each of our parents, spouses, and children, thank you for your unending support during the many years of our education and training, for your understanding of the unique demands of our professional calling, for your grace in allowing us the many long days and late nights in the care of our patients, and for allowing us the significant time required to complete this text as a gift to the next generation of surgeons. To our Patients We are truly grateful to the many thousands of patients who place their collective trust in our hands each year. We strive for perfection every day, work to make continuous improvements over time, and we are deeply indebted to your belief and confidence in our abilities. We hope this text serves to improve the care of patients around the world in the many years and decades ahead.

To Jamie, Grey, and Matthew Rubin, Marilyn and Richard Rubin, Carole and Bill Labell, and Isrella and Howard Abrams: I am deeply grateful for your lifetimes of love and support. To Kris Keggi, Michael Ehrlich, and Gary Friedlaender, I will be forever grateful for your mentorship and friendship. To Ed Akelman, Mary O’Connor, Ted Blaine, Jon Grauer, and Lisa Lattanza, thank you for believing in me and for helping to guide my personal and professional growth at every stage of my academic career. Lee E. Rubin, MD, FAAOS, FAAHKS, FAOA Dr. Kris Keggi and I conferred many years ago at a meeting and shared our vision of a book dedicated to anterior hip surgery. The first edition proved to be remarkably successful. Other books addressing anterior hip surgery have since appeared, a testimony to how a classic approach to the hip joint has been increasingly adopted in the modern era, thanks to new implants and instruments, a rich collaboration among peers, and the tireless dedication to teaching by pioneering surgeons, such as Drs. Joel Matta and Kris Keggi, to whom we owe a special debt of gratitude. On behalf of the editorial team, I want to convey a special thank you to Dr. Lee E. Rubin, who undertook the herculean task of updating the first edition of our book, even with his busy professional responsibilities. With Lee’s leadership, we expanded and updated the contents, while encompassing the experience and perspectives of international scholars into this 2nd edition. With new authors and section editors, this refreshed work should serve surgeons worldwide, and help improve patient outcomes. Since the first edition, while my career has taken new directions into law and corporate management, at heart I will always be an orthopaedic surgeon, and proudly so. No words can properly acknowledge the generous support and encouragement of my wonderful family, from parents, to children, and above all, my wonderful wife Dana. My gratitude and respect also go out to my fellowship mentor Dr. William Harris, and to the late Dr. Bill Allen at the University of Missouri, whose quiet guidance and support built my arthroplasty career, and sparked a lasting interest in ceramic biomaterials. B. Sonny Bal, MD, MBA, JD, PhD To my beloved wife, Pam, whose unwavering support has been the foundation upon which I have built my career and pursued my passion for orthopaedic surgery. Your constant encouragement, patience, and understanding have been my guiding light, and I dedicate this textbook to you. Thank you for being my rock and standing by my side throughout this journey. To my mentors, Drs. Louis Ripley, Bob Pruner, Gwo Wang and Les Borden, whose invaluable guidance and expertise shaped me into the orthopaedic surgeon I am today. Your wisdom, mentorship, and belief in my abilities were instrumental in my development and success. I am forever grateful for the opportunities you provided and the knowledge you imparted. This textbook is a testament to your dedication and commitment to the advancement of orthopaedic surgery, and this work is dedicated to your memory.

And finally, to my entire family, whose unconditional love and support have been a constant source of strength and motivation. This textbook is dedicated to you, as a token of my gratitude for your unwavering support and belief in my abilities. Joseph T. Moskal, MD, FAAOS, FAAHKS, FAOA, FACS Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2024

In Memoriam

grandfather Luda Bērziņš in Jūrmala, Latvia; established the “Keggi Velo,” a bike race in memory of his father; and was the founder of the Luda Bērziņš Prize. Keggi was the first surgeon to perform total hip arthroplasty using the minimally invasive anterior approach in the 1970s and published his early experi ences and case series for the scientific community. He is widely considered to be the pioneer, innovator, and advocate for the anterior approach in the United States. In 2016, Dr. Keggi collaborated with Drs. Sonny Bal and Lee E. Rubin to publish The Direct Anterior Approach to Hip Reconstruction . He was the recipient of multiple national and interna tional awards and four honorary doctorates. These have included 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 received the George H.W. Bush Lifetime of Leadership Award from Yale University in 2005. In 1994, the Pauls Stradiņš Museum of the History of Medicine and the Latvian Academy of the Sciences awarded him the Pauls Stradiņš Prize. Keggi is an Honorary Member of the Latvian Academy of Sciences (1990) and the Russian Academy of Sciences (1993), and holds honorary degrees from the Riga Stradiņš University (1997) and the University of Latvia (2009). He also received the 2019 Humanitarian Service Award from the Connecticut Orthopaedic Society. He is one of only two non-Russians inducted into the Russian Academy of Sciences for his prowess in medi cine. Keggi spoke six languages fluently, was captain of the Yale fencing team as an undergraduate, and later ran six marathons, competed in master’s rowing events, and was a passionate golfer. Over the course of his life, he nobly served many people and institutions. His work in a MASH unit in Vietnam, numerous contributions to the field of medicine in the United States and his native Latvia, and devotion to veterans were documented in his self-published 2022 memoir, My Century: A Memoir of

Kristaps Juris Keggi, MD

Kristaps Juris Keggi, MD, (1934 2023) was Professor Emeritus at the Yale University School of Medicine, Department of Orthopaedics & Rehabilitation. On July 4, 2023, he passed away peacefully and unex pectedly in his home at age 88. His extraordinary life began in Riga, Latvia on August 9, 1934, when he was born in the family

of surgeon Jānis and Ruta Kegi as the second of four brothers. His grandfather was folklorist, teacher, and pastor Ludis Bērziņš (1870-1965). During World War II, he fled with his family to Germany in 1944 then to the United States in 1949. He studied medicine at Yale University (1951-1959) and completed his surgical internship at the Roosevelt Hospital in New York fol lowed by Residency in Orthopaedic Surgery at Yale-New Haven Hospital in 1965. From 1965 to 1966, he partic ipated in the Vietnam War as a military surgeon, and was stationed with the 173rd Airborne as Chief of Surgery at the 3rd Mobile Army Surgical Hospital in Biên Hòa, Vietnam. In 1966, he rejoined the Yale University faculty as an assistant professor. Dr. Keggi was in clinical practice from 1966 through 2016, performing orthopaedic surgery at both St. Mary’s Hospital (1969-1989) and Waterbury Hospital (1969 2018). He served as the director of Waterbury Hospital’s Orthopaedic Center for Joint Reconstruction and as a Senior Research Scientist at the Yale School of Medicine during that time. In 1989, Dr. Keggi became a Clinical Professor of Orthopaedics & Rehabilitation at Yale University, was elected full professor in the Department at Yale in 2008, was named Elihu Professor of Orthopaedics and Rehabilitation in 2010, and retired from clinical practice to become a Professor Emeritus on December 31, 2016. Since 1987, he regularly visited Latvia, where he per formed demonstration operations, conducted seminars, and delivered numerous lectures both in Latvia and the surrounding Baltic Nations. In 1988, he founded the nonprofit Keggi Orthopaedic Foundation to allow for formal academic exchanges between the United States and the USSR. The organization provided fellowships in advanced orthopaedic surgery at both the Yale School of Medicine and Waterbury Hospital for more than 300 surgeons from the Baltic nations, Russia, and Vietnam. In 1990, he founded the memorial museum of his

War, Peace, and Pioneering in the Operating Room . His life as husband, father, father-in-law, and grandfa ther were also extraordinary. The last few weeks of his life were filled with family activities and events. He attended the college graduation of his twin grandsons, Alexander and Christopher Ford from Fairfield University and the wedding of his granddaughter Julia Hunter in New Orleans. Although no longer able to play golf, he Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2024

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continued to enjoy his affiliations with the Country Club of Waterbury and Highfield. He was thinking about retiring but maintained that working was his lifestyle of choice. He remained an active father, grandfather, teacher, mentor, healer, and inspiration to all who were fortunate enough to know him. Keggi was preceded in death in March 2022 by his beloved wife of 64 years, Julia Grant Quarles. The couple first met on the steps of Buckingham Palace in London during a tour of Europe in the 1950s. They were

married a year later and ultimately moved to Middlebury, Connecticut in 1969, where Kris and Julie became pil lars of the Middlebury Congregational Church and their broader community. Kris and Julie are survived by their three daughters Catherine Keggi Hunter (Howard), Mara Keggi Ford (Donald), Caroline Saunders Keggi (Connie Wilson) and five grandchildren George Quarles Hunter (Caitlion), Julia Hunter Bookman (Zachary), Christopher Daly Ford, Alexander Walden Ford, and Eliza Hannah Ford.

About the Editors

orthopaedic journals and has published over 140 peer-re viewed scientific articles and book chapters. Dr. Rubin is one of the world’s leading experts in the minimally invasive direct anterior approach (DAA) technique, has been an invited lecturer on multiple con tinents, and has been an invited faculty member for the International Congress for Joint Reconstruction’s Annual DAA Course and the International Master’s Anterior Course for the past 13 years. In 2016, he published the world’s first comprehensive book on anterior hip surgery, The Direct Anterior Approach to Hip Reconstruction , which quickly became a landmark reference used by surgeons around the world, with the second edition of this text reaching print in 2024. Dr. Rubin resides in Connecticut with his wife Jamie along with their two children, and their two rescued beagle mix dogs.

EDITOR-IN-CHIEF Lee E. Rubin, MD, FAAOS, FAAHKS, FAOA

Lee Eric Rubin, MD, is a fellow ship trained, board-certified ortho paedic surgeon, who currently serves as an Associate Professor of Orthopaedics & Rehabilitation with Yale Medicine and the Yale University School of Medicine in New Haven, Connecticut. Originally from New Jersey, Dr. Rubin matriculated as a Presidential

Scholar at Brandeis University and graduated cum laude in 2000. He then graduated with Alpha Omega Alpha distinction from the Tufts University School of Medicine in 2004 and completed Orthopaedic Surgery Residency training at Yale in 2009. This was followed by an adult reconstruction fellowship in 2010 with Dr. Kristaps J. Keggi and the Keggi Orthopaedic Foundation at the Waterbury Hospital in Connecticut. Dr. Rubin spent 5 years in practice with University Orthopedics, Inc. and Lifespan, while serving as Assistant Professor of Orthopaedic Surgery on the fac ulty of the Warren Alpert Medical School of Brown University in Providence, Rhode Island. In this role from 2011 to 2016, he was actively engaged at The Miriam Hospital’s Total Joint Center and was the Rhode Island Arthritis Foundation Chapter’s “Medical Honoree” at the Providence Walk to Cure Arthritis event in 2015. At age 35, Dr. Rubin was selected as one of the “Forty Under 40” by the Providence Business News, becoming the first orthopaedic surgeon to win this honor in Rhode Island. In late 2016, Dr. Rubin was appointed as the Section Chief for Yale University’s Division of Adult Reconstruction and as the Chief of the Yale New Haven Hospital’s Total Joint Replacement Program. He later became the founding Program Director for the Yale Arthroplasty Fellowship, which commenced in August 2021. He was selected as one of Castle Connolly’s & Connecticut Magazine’s in 2019, 2020, 2022, 2023, and 2024. Academically, he has served as a reviewer and editorial board member for a number of prestigious

SENIOR EDITORS B. Sonny Bal, MD, MBA, JD, PhD

Dr. Sonny Bal served as Professor of Orthopaedic Surgery and Adjunct Professor of Material Sciences at the University of Missouri, with over 25 years of clinical experience as an orthopaedic surgeon, and consulting attorney. Dr. Bal has an extensive background in research, with multiple publications in peer- reviewed journals.

Dr. Bal was appointed to the Board of Directors of SINTX Technologies in 2012, and currently serves as the CEO and President of that organization. Most recently, Dr. Bal has served on the Board of Trustees of the OREF (Orthopaedic Research and Education Foundation). He earned his MD from Cornell University along with an MBA from Northwestern University, JD from the University of Missouri, and a PhD in Materials Engineering from the Kyoto Institute of Technology in Japan. He completed his Adult Reconstruction Fellowship at Harvard Medical School with Dr. William Harris in Boston, Massachusetts. Dr. Bal lives in Columbia, Missouri with his wife and four children. Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2024

About the Editors

Joseph T. Moskal, MD, FAAOS, FAAHKS, FAOA, FACS

ASSOCIATE EDITORS H. John Cooper, MD

Joseph T. Moskal, MD, is a native of Brooklyn, New York. He received his BA from the State University of New York at Binghamton, graduat ing summa cum laude and elected to the prestigious Phi Beta Kappa honor society. After receiving his medical degree from Washington University School of Medicine in St. Louis, Missouri, he completed

Dr. Cooper is an associate professor of orthopaedic surgery at Columbia University Irving Medical Center in New York City, with a busy clinical practice focusing on ante rior approach hip arthroplasty and complex anterior revision surgery. An active educator and researcher, he has published over 130 peer-re viewed articles and book chapters

his orthopaedic residency at the University of Virginia Medical Center. He then completed his fellowship in Adult Reconstruction and Total Joint Replacement at the Cleveland Clinic, followed by an Orthopaedic Traumatology fellowship at the Maryland Institute for Emergency Medical Services System in Baltimore. Dr. Moskal joined the medical staff of Carilion Roanoke Memorial Hospital in 1988. He currently serves as chair of the Department of Orthopaedic Surgery and chief of Adult Reconstruction at Carilion Clinic in Roanoke, Virginia. He is also chair and pro fessor of the Department of Orthopaedic Surgery at Virginia Tech Carilion School of Medicine, and associate professor at the University of Virginia Medical School and the Edward Via College of Osteopathic Medicine. He has trained numerous orthopaedic surgery resi dents and more than 25 fellows in adult reconstruction. His multiple honors and awards include membership to Alpha Omega Alpha, the University of Virginia Resident Teaching Award, the Virginia Orthopaedic Society Lifetime Achievement Award, and the American Academy of Orthopaedic Surgery (AAOS) Achievement Award. He is a Fellow of the AAOS, a Fellow of the American Association of Hip and Knee Surgeons (AAHKS), past chair of the AAOS Exhibits Committee, and past chair of the Education Committee for AAHKS. He served as chair and faculty member of the International Congress for Joint Reconstruction Direct Anterior Approach Total Hip Meeting for the past 11 years. Dr. Moskal is the current inaugural co-chair of the International Masters Anterior Course. He is also a member of both the Hip Society and the Knee Society, the highest honors bestowed upon an orthopaedic surgeon in adult reconstruction. Dr. Moskal has authored over 140 publications in ref ereed journals, over 40 published abstracts, and serves as a reviewer for several prestigious orthopaedic jour nals. In addition, he has contributed to over 40 scien tific exhibits at national and international meetings. He is a highly respected teacher, having been invited to be a guest speaker, faculty member, and instructor at both national and international meetings. Dr. Moskal and his wife, Pam, have four children, one grandchild and reside in Roanoke, Virginia.

and regularly participates in national and international meetings. Originally from South Carolina, Dr. Cooper graduated from Duke University with a degree in mechanical engineering and materials science, and then completed his medical education at Columbia University, residency at Lenox Hill Hospital, and fellowship at Rush University Medical Center. Kristoff Corten, MD, PhD

Prof. Dr. Kristoff Corten is a fel lowship trained surgeon who spe cializes in reconstructive surgery of the hip joint. He focused on mus cle-sparing surgery of the hip joint, both for joint preservative and for joint reconstructive procedures. During his doctoral research, he focused on the anatomy of the cap sular releases of the direct anterior

approach. He conducted cadaver and clinical research on the efficient direct anterior (EDA) hip procedure. Prof. Dr. Corten optimized the OR-setting of the DAA. He focused on teamwork, instrument tray reduction, and process optimization. He developed the “Efficient SurgerY” (ESY) concept of which parallel processing is the most important key feature. Prof. Dr. Corten welcomes hundreds of visiting surgeons from all over the world. He is (co-)author of over 80 scientific papers and textbook chapters. He is an invited speaker at many world class meetings. Jeremy M. Gililland, MD, FAAOS, FAAHKS

Dr. Jeremy M. Gililland is fellow ship trained in adult reconstruc tive orthopaedic surgery of the hip and knee, with a focus on direct anterior total hip arthroplasty and revision hip and knee arthroplasty procedures. Prior to his medi cal education, Dr. Gililland stud ied Mechanical Engineering and Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2024

About the Editors

this background led him to the field of Orthopaedic Surgery, and more specifically into the specialty of total joint arthroplasty. He is now an associate professor of Orthopaedic Surgery at the University of Utah and enjoys training residents and fellows in adult reconstruction. Dr. Gililland’s research interests are focused on the biomechanics of hip and knee replacements, revision joint replacement techniques, the use of intraoperative fluoroscopy to improve implant positioning, and peri prosthetic joint infection. His efforts have resulted in the development of a fluoroscopic navigation system to combat the problem of distortion, and development of a collaborative team of researchers aimed at exploring the heritable risk of periprosthetic joint infections. He has published over 100 papers and book chapters and enjoys teaching on the national and international stage. Theodore Manson, MD, MS

or infections around existing hip and knee replacements and directed the Maryland Statewide Referral System for these patients. He also had a hip and knee replacement practice at St Joseph’s Hospital during this time. Dr. Manson now limits his practice to patients with arthritis and provides treatments ranging from early treatments for arthritis to joint replacement surgery. His research interests include complex revision hip replace ment, periprosthetic fractures, and rapid recovery proto cols following hip and knee surgery. J. Bohannon Mason, MD

J. Bohannon Mason, MD, is an attending surgeon at OrthoCarolina Hip and Knee Center and Professor of Orthopedic Surgery at Atrium Musculoskeletal Institute in Charlotte, North Carolina. He was the Thomas Savage award recipi ent as the most outstanding med ical student in his class at Medical

Dr. Manson received his medi cal degree from Northwestern University School of Medicine and completed his residency in orthopaedic surgery at the Johns Hopkins Hospital. He pursued an additional year of advanced training in the management of complex frac tures at the R Adams Cowley Shock Trauma Center in Baltimore. He

University of South Carolina and completed his intern ship and residency at Duke University Medical Center. He was an Otto Aufranc Fellow in adult reconstructive surgery at New England Baptist Hospital before joining Charlotte Orthopedic Specialists in Charlotte, a predi cate organization to OrthoCarolina, where he continues to practice.

followed with an additional one-year fellowship in total joint replacement at the Hospital for Special Surgery in New York, where he trained in minimally invasive joint replacement, revision joint replacement, and hip and knee surgery. From 2009 to 2019 Dr. Manson was an ortho paedic trauma surgeon at the R Adams Cowley Shock Trauma Center and cared for patients with complex frac tures and multisystem trauma. In addition, he cared for patients from Maryland, Pennsylvania, Delaware, and West Virginia who were referred for complex fractures Dr. Mason has spent more than 20 years in the study and pursuit of tissue-sparing reconstructive surgery of the hip, with particular focus on direct anterior, and has authored numerous studies and delivered more than 150 lectures on related topics. His research interests have focused on early recovery following direct anterior total hip arthroplasty, component orientation, exposure techniques, and the contribution of capsule structures to total hip arthroplasty stability. His influence on the field is additionally expanded through the education of visit ing surgeons, residents, and fellows. Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2024

Foreword

In his recent book Innovators , Walter Isaacson describes some of the common characteristics of inno vators and innovations. Based on my understanding, and I could be mis taken of course, an idea or a product will be considered as a true innova tion only if it improves on the state of the art and provides better life for

endovascular surgery, mostly vascular and cardiac sur geons, have now found themselves in the middle of a shrinking subspecialty. Their skill to handle a #10 knife is not required any more. Interventional radiologists/ cardiologists have come to celebrate the birth of a new profession, and, once again, the patients are the benefi ciaries of these innovations. I realize that to some performing a total hip arthro plasty through the direct anterior approach (DAA) may not be seem as great of a leap as laparoscopic or endovascular surgery. However, one common denomi nator between these innovations does clearly exist. The innovators in orthopaedics also wished to depart from an imperfect status quo. They strived to elevate the pro fession to a different height. Be it the continued limp after direct lateral approach, the high dislocation rate after posterior approach, or whatever the other issues were with the status quo, the innovators chose to travel a different journey. I started performing DAA hip arthroplasty in 2005. I soon realized the difference in outcomes that our patients experienced. I was convinced it was the right solution to many problems, and I set out to perfect the technique in my operating room. I was a proponent of the technique and did not shy away from expressing such devotion. I recall a heated debate in a meeting in Brazil. My opponent, a well-known and respected surgeon and ex-president of the American Academy of Orthopaedic Surgeons, decided to use mockery to argue his points. The moderator of the session, also an ex-president of the American Academy of Orthopaedic Surgeons and clearly not aware of his responsibility of remaining neutral to the debate, also resorted to “humor” to stress his points. I walked off the stage feeling defeated but further devoted to the cause. The DAA has stood the test of time. Based on the 2018 American Association of Hip and Knee Surgeons audience survey, over 40% of surgeon members were using the DAA as their preferred approach for total hip arthroplasty, with the numbers increasing yearly. Over 80% of the adult reconstruction fellows that we gradu ate now embrace the DAA and use it routinely on their patients. The early trickle of high-quality publications that demonstrate the superiority of DAA has now gained cadence and force in the literature.

the beneficiaries/users. Of course, not every innovation fulfills those criteria from the day it is launched. Every innovation undergoes many refinements and modifica tions. Only those that fulfill these criteria survive. I was an intern (house officer) in the United Kingdom when the first laparoscopic cholecystectomy was being performed. I remember we had all lined up to watch the surgery from the “gallery.” The procedure took 4.5 hours and calling the surgery smooth would be far from the truth. The patient stayed in the hospital for 11 days because she had developed postoperative ileus. The ini tial experience with laparoscopic procedures was far from perfect. The numerous “new” complications such as clip ping of bile ducts, liver laceration, and others were being described in case reports and case series. I recall watch ing debates on the podium, with one opponent of lap aroscopic cholecystectomy calling the procedure “a gift from hell.” The opponents of laparoscopy had the upper hand early on. The audience clapped and applauded the opponents of the procedure, and for the most part, the debates were considered a total win for those who opposed laparoscopic techniques. The concept and what it could bring to the patients was clearly a huge milestone in modern medicine. The innovators, those without fear, persevered and contin ued to innovate. They were able to divorce themselves from the emotions and seek a journey that would depart from the status quo. We all know where that story ends. Today, laparoscopic cholecystectomy is performed rou tinely as an outpatient procedure, and the lengthy sub costal incisions or the continued incisional pain is a phenomenon of the past. In fact, laparoscopic technique has become the new “standard of care” in general sur gery for nephrectomy, colectomy, bariatric surgery, and many other operations. There are many examples of such accomplish ments and quantum leaps in medicine and surgery. Endovascular technique is another such example. The disruptive nature of endovascular innovations changed the balance of surgical specialties. Many skeptics of

Even podium debates do not appear to be one sided any more. Many former opponents of the technique now realize the value of this surgical approach. In fact, many established surgeons have converted their practice to use Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2024

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the DAA to the hip, with reasoning discussed in detail by four expert surgeons in Chapter 3 within the first section of this textbook. Our informed patients continue to seek out surgeons who use this anatomic approach to the hip. The DAA in the world of hip reconstruction, much like laparoscopy and endovascular techniques in surgery, is here to stay. I want to congratulate Drs. Bal, Moskal, and Rubin for putting together this second-edition textbook publi cation. In doing so, they have compiled a great collection of chapters written by authorities in the field that captures

the broad value of the DAA for total hip arthroplasty. This scholarly work comprehensively presents unbiased and valuable perspectives related to the DAA to the hip. I am excited to have a copy of the book on my shelf. Our profession remains indebted to innovators who strive to better the lives of our patients. Javad Parvizi, MD, FRCS Sidney Kimmel School of Medicine Rothman Institute at Thomas Jefferson University Philadelphia, Pennsylvania

Contributors

Murillo Adrados, MD Assistant Professor Department of Orthopedic Surgery Virginia Tech Carilion School of Medicine Carilion Clinic Roanoke, Virginia Daniel C. Allison, MD, MBA, FACS Assistant Director of Orthopedic Oncology Department of Orthopedic Surgery Cedars-Sinai Medical Center, Children’s Hospital of Los Angeles Los Angeles, California Lucas Anderson, MD Orthopaedic Surgeon Department of Orthopaedics

Paul Beaule, MD, FRCSC Professor of Surgery Department of Orthopaedic Surgery University of Ottawa Ottawa, Canada Jaime L. Bellamy, DO, MS Arthroplasty Surgeon Department of Orthopaedics & Rehabilitation Womack Army Medical Center Fort Bragg, North Carolina Keith R. Berend, MD Senior Partner/JIS Orthopedics & Chief Medical Development Officer/Orthoalliance Orthopedics-Adult Reconstruction of the Hip and Knee JIS Orthopedics New Albany, Ohio Jenna A. Bernstein, MD Clinical Assistant Professor of Surgery Connecticut Orthopaedics Western Michigan University Homer Stryker MD School of Medicine/Bronson Methodist Hospital Kalamazoo, Michigan Hari P. Bezwada, MD Adult Reconstruction Surgeon Department of Orthopaedic Surgery Princeton Medical Center-Penn Medicine Plainsboro, New Jersey Jordan Brand, MD Orthopaedic Surgeon Covenant Healthcare Saginaw, Michigan Andrzej Brzezinski, MD 2023-24 Yale Arthroplasty Fellow and Clinical Instructor Quinnipiac University Fairfield, Connecticut Christopher J. Betzle, MD Clinical Assistant Professor Orthopaedic Surgery

University of Utah Salt Lake City, Utah Carlos Ovares-Arroyo, MD Attending Surgeon

Department of Orthopedic Surgery Centro Nacional De Rehabilitación

San José, Costa Rica Diren Arsoy, MD, MSc Orthopedic Surgeon, Rothman Orthopaedic Institute Department of Orthopedic Surgery NYU Langone Orthopedic Hospital, NYU Grossman

School of Medicine New York, New York B. Sonny Bal, MD, MBA, JD, PhD Chief Executive Officer & President

SINTX Technologies Salt Lake City, Utah Matthew Baron, MD Orthopedic Trauma Surgeon Multicare Good Samaritan Hospital Puyallup, Washington Sahil Batra, MS Assistant Professor Department of Orthopaedics Department of Orthopaedics All India Institute of Medical Sciences (AIIMS) New Delhi, India Department of Orthopaedic Surgery Yale University School of Medicine New Haven, Connecticut Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2024

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Contributors

Aaron J. Buckland, MBBS, FRACS, FAOrthA Associate Professor, Spine and Scoliosis Surgeon Melbourne Orthopaedic Group Spine and Scoliosis Research Associates Australia Monash University Melbourne, Victoria, Australia Kevin Campbell, MD Orthopaedic Surgeon Orthopedic & Sports Institute Appleton, Wisconsin Antonia F. Chen, MD, MBA Director of Research, Arthroplasty Services Associate Professor, Harvard Medical School Department of Orthopaedics, Brigham and Women’s Hospital Boston, Massachusetts John C. Clohisy, MD Daniel C. and Betty B. Viehmann Distinguished Professor St. Louis, Missouri Eric M. Cohen, MD Assistant Professor of Orthopedic Surgery Warren Alpert Medical School at Brown University Providence, Rhode Island Benjamin R. Coobs, MD Assistant Professor, Department of Orthopaedic Surgery Program Director, Adult Reconstruction Fellowship Chief, Adult Reconstructive Surgery Department of Orthopedic Surgery Washington University School of Medicine

Kristoff Corten, MD, PhD Hip Unit Orthopedic Department Ziekenhuis Oost-Limburg, Genk Associate Professor Department of Rehabilitation Sciences University of Hasselt Hasselt, Belgium Heuppraktijk/European Hip Clinic Herselt, Belgium Park Medisch Centrum Rotterdam, The Netherlands David A. Crawford, MD

Medical Director, JIS Research Institute Orthopedic Surgeon, JIS Orthopedics New Albany, Ohio Chief Executive Officer, Walnut Creek Surgical Suites Gahanna, Ohio Department of Surgery Chief, Mount Carmel New Albany New Albany, Ohio Roy I. Davidovitch, MD Julia Koch Associate Professor of Orthopedic Surgery Orthopedic Surgery NYU Langone Orthopedic Hospital New York, New York Sarvang (Sam) Dalal, PT, DPT, MSPT, MTC, FAAOMPT Director of Physical Therapy Department of Physical Therapy INOV8 Orthopedics Houston, Texas Jimmy Angulo De La O, MD Attending Surgeon Department of Orthopedic Surgery San Juan De Dios Hospital

Virginia Teach Carilion School of Medicine Carilion Clinic-Institute for Orthopaedics and Neurosciences

Roanoke, Virginia H. John Cooper, MD

San José, Costa Rica Matthew E. Deren, MD Assistant Professor Orthopaedic Surgery

Associate Professor of Orthopedic Surgery Columbia University Irving Medical Center New York Presbyterian Hospital New York, New York Logan Cooper, DO

xvi

Contributors

Benjamin G. Domb, MD Medical Director American Hip Institute American Hip Institute Research Foundation Chicago, Illinois

Jeremy M. Gililland, MD, FAAOS, FAAHKS Chief of Orthopaedic Surgery George E. Whalen VA Medical Center Director of Research for Adult Reconstruction Service Associate Professor of Orthopedic Surgery Division of Adult Reconstruction

Steven Donohoe, MD Orthopaedic Surgeon

University of Utah Salt Lake City, Utah

Kaiser Permanente Hospital Panorama City, California Ronald Driesen, MD Orthopedic Surgeon Ziekenhuis Oost Limburg Genk, Belgium

Simon Greenbaum, MD Orthopedic Surgeon Orthopaedic Associates of Manhasset

Great Neck, New York Preston W. Grieco, MD Associate Staff Adult Reconstruction, Department of Orthopedics Cleveland Clinic Florida Weston, Florida Tyler D. Goldberg, MD Orthopedic Surgeon Austin Orthopedic Institute Austin, Texas Admir Hadzic, MD, PhD Anesthesiologist ZOL Genk, Belgium KU Leuven Leuven, Belgium William G. Hamilton, MD Fellowship Director Anderson Orthopedic Postgraduate Fellowship Anderson Orthopedic Clinic Alexandria, Virginia Erik J. Hansen, MD Assistant Professor Department of Orthopedics Medical University of South Carolina Charleston, South Carolina Nathan Haile, MD Orthopedic Surgeons Texas Orthopedic Specialists, PLLC Bedford, Texas Sarah O’Reilly-Harbidge, BMed, FRACS(Orth), FAOrthA, MIPDEd

Jenaro A. Fernández-Valencia, MD, PhD Orthopaedic Surgeon Head of Hip Unit Department of Orthopaedic Surgery and Traumatology Hospital Clínic, University of Barcelona Barcelona, Spain Adam M. Freedhand, MD, FAOA, FAAOS, FAAHKS Assistant Professor Department of Orthopedic Surgery University of Texas Houston, Texas

Mark Froimson, MD, MBA Chief Executive Officer Riverside Health Advisors Chagrin Falls, Ohio David B. Frumberg, MD Assistant Professor Orthopaedics and Rehabilitation

Yale School of Medicine New Haven, Connecticut Deepak Gautam, MS, FACS Consultant Joint Replacement and Director of Orthopedic Disciplines Department of Orthopedics Medicover Hospital Navi Mumbai, Maharashtra, India Jeffrey A. Geller, MD, FAAOS Nas S Eftekar Professor and Vice Chair of Orthopedic Surgery Chief of Orthopedic Surgery-New York Presbyterian Westchester Chief, Division of Hip and Knee Reconstruction -

Columbia University Medical Center Department of Orthopedic Surgery Columbia University Medical Center New York, New York

xvii

Contributors

Sebastian Heaven, MBBCh(UK), MSc, FRCSC Consultant Orthopaedic Surgeon

Timothy Kahn, MD Orthopaedic Surgeon

Department of Surgery Ross Memorial Hospital Lindsay, Ontario, Canada

St Mark’s Hospital Salt Lake City, Utah Stephen Kayiaros, MD University Orthopaedic Associates Somerset, New Jersey Kristaps J. Keggi, MD, Dr Med (hc) (deceased) Professor Emeritus Yale University School of Medicine Department of Orthopaedics and Rehabilitation New Haven, Connecticut Department of Orthopaedic Surgery University of Nebraska Medical Center Omaha, Nebraska Ramya Krishnan, MD, MBA Anesthesiologist Hunterdon Medical Center Flemington, New Jersey Stefan W. Kreuzer, MD, MSc Owner, CEO INOV8 Orthopedic Houston, Texas Justin Kuether, MD Orthopedic Surgeon Department of Orthopedics and Sports Medicine Maine Medical Center Portland, Maine Samuel T. Kunkel, MD, MS Orthopaedic Surgeon Department of Orthopaedic Surgery Dartmouth Health Manchester, New Hampshire Brent A. Lanting, MD, FRCSC, MSc, BESC Associate Professor Orthopaedic Surgery London Health Sciences Center London, Ontario, Canada Frederick Laude, MD Orthopedic Surgeon Clinique Du Sport Paris, France Michael P. Leslie, DO, FAOA Associate Professor of Orthopaedics Department of Orthopaedics and Rehabilitation Beau J. Kildow, MD Assistant Professor

Matthew S. Hepinstall, MD Associate Professor Department of Orthopedic Surgery

NYU Langone Health New York, New York

Mark Hood, MD Orthopedic Surgeon, Fellowship in Adult Reconstruction Adult Hip and Knee Joint Reconstruction Community Heath Network Indianapolis, Indiana

John V. Horberg, MD Adult Reconstructive Surgery Premier Bone & Joint Centers Laramie, Wyoming

William J. Hozack, MD Walter Annenberg Professor of Joint Replacement

Sidney Kimmel Medical School Thomas Jefferson University Rothman Orthopaedics Philadelphia, Pennsylvania Michael Huo, MD Professor Department of Orthopedic Surgery UT Southwestern Medical Center Dallas, Texas

Mazin Ibrahim, MBChB, MCh, MSc, MRCS, FRCS (T&O) Consultant Orthopaedic Surgeon Trauma and Orthopaedic Department Whittington Health NHS Trust London, United Kingdom

Maiken Jacobs, MA, OTR/L, CGCP Preoperative Patient Educator

Department of Service Line Orthopedics New York Presbyterian Hospital/CUIMC New York, New York David Jevsevar, MD, MBA Chief Executive Officer Orthovirginia Richmond, Virginia Atul F. Kamath, MD, MBA Professor Yale School of Medicine New Haven, Connecticut Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2024 Cleveland Clinic Cleveland, Ohio

xviii

Contributors

Michael Leunig, MD CMO, Head of Orthopedics Department of Orthopedics Schulthess Klinik Zürich, Switzerland Matthew M. Levitsky, MD Orthopedic Surgeon Columbia University Medical Center

Edward R. Mariano, MD, MAS, FASA Professor and Senior Vice Chair Department of Anesthesiology, Perioperative and Pain Medicine Stanford University School of Medicine Chief, Anesthesiology and Perioperative Care Service Veterans Affairs Palo Alto Health Care System President, California Society of Anesthesiologists Chair, American Society of Anesthesiologists Section on Education and Research Palo Alto, California J. Bohannon Mason, MD Adult Reconstructive Surgery Professor of Orthopedic Surgery OrthoCarolina Hip and Knee Center Atrium Musculoskeletal Institute Charlotte, North Carolina John L. Masonis, MD Orthocarolina Hip and Knee Center Professor of Orthopaedics Director of Adult Hip/Knee Reconstruction Residency Education Atrium Musculoskeletal Institute Charlotte, North Carolina Alexander S. McLawhorn, MD, MBA Assistant Professor of Orthopaedic Surgery Hospital for Special Surgery New York, New York Steven Mennona, MD Orthopaedic Surgeon Adult Reconstruction and Traumatology Brielle Orthopaedic Institute

New York, New York Jinlei Li, MD, PhD, FASA Associate Professor Program Director of Regional Anesthesia and Acute Pain Medicine Fellowship Yale University Department of Anesthesiology Director of Regional Anesthesia Yale New Haven Health New Haven, Connecticut Elizabeth G. Lieberman, MD Orthopaedic Surgeon Orthopaedic and Fracture Specialists Portland, Orlando Adolph V. Lombardi Jr, MD, FACS President, JIS Orthopedics President of Medical Staff Services, Mount Carmel New Albany Vice President, White Fence Surgical Suites New Albany, Ohio Clinical Assistant Professor Department of Orthopaedics The Ohio State University College of Medicine Columbus, Ohio Tim P. Lovell, MD Orthopedic Surgeon Providence Medical Group Spokane, Washington David R. Maldonado, MD Assistant Professor Department of Orthopaedic Surgery Mcgovern Medical School University of Texas Health Science Center at Houston University of Texas at Houston Houston, Texas Rajesh Malhotra, MS, FRCS, FACS, FICS, FICS, FIMSA, FAMS, FNASc Professor and Head Department of Orthopaedics All India Institute of Medical Sciences (AIIMS) New Delhi, India Theodore Manson, MD, MS Clinical Professor of Orthopaedic Surgery University of Maryland Baltimore, Maryland

Freehold, New Jersey Kenneth Milligan, MD Orthopaedic Surgeon Orthopedic ONE Dublin, Ohio Michael B. Millis, MD

Professor of Orthpaedic Surgery Department of Orthpaedic Surgery Boston Children’s Hospital Boston, Massachusetts David A. Molho, MD Orthopaedic Surgeon South County Orthopaedic Specialists Laguna Woods, California Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2024

xix

Contributors

Joseph T. Moskal, MD, FAAOS, FAAHKS, FAOA, FACS Professor and Chairman Department of Orthopaedic Surgery Virginia Tech Carilion School of Medicine (VTCSOM) Chief and Fellowship Director, Adult Reconstruction (Hip and Knee) Carilion Clinic and VTCSOM Associate Professor University of Virginia Medical School Associate Professor Edward Via College of Osteopathic Medicine Chairman, Department of Orthopaedic Surgery Carilion Clinic Senior Vice President, Carilion Clinic Roanoke, Virginia Wayne Moschetti, MD, MS Chief of Arthroplasty Department of Orthopaedics Dartmouth Hitchcock Medical Center Lebanon, New Hampshire Alexander L. Neuwirth, MD Associate Residency Program Director Assistant Professor of Orthopedic Surgery Division of Adult Hip and Knee Reconstruction Columbia University Medical Center New York-Presbyterian Hospital New York, New York Michael Nogler, MD, MA, MAS, MSc Professor of Experimental Orthopaedics Department of Orthopaedics and Traumatologie Medical University of Innsbruck Innsbruck, Austria Department of Orthopaedics and Rehabilitation Yale School of Medicine, Yale New Haven Hospital New Haven, Connecticut Adriana D. Oprea, MD Associate Professor of Anesthesiology Department of Anesthesiology Yale School of Medicine New Haven, Connecticut Alexander Orem, MD, MS Associate Professor of Orthopaedic Surgery Christophe Olyslaegers, MD Resident Physician Adam Y. Nasreddine, MD, MA Fellow Department of Orthopaedic Surgery Boston Children’s Hospital Boston, Massachusetts

Gil Ortega, MD, MPH, FAOA Fellowship Director and Orthopaedic Trauma Director Department of Orthopaedics Sonoran Orthopaedics Scottsdale, Arizona Trevor M. Owen, MD Associate Professor Carilion Clinic, Department of Orthopaedic Surgery Virginia Tech Carilion School of Medicine Roanoke, Virginia Javad Parvizi, MD James Edwards Professor of Orthopaedic Surgery Sidney Kimmel School of Medicine Rothman Institute at Thomas Jefferson University Philadelphia, Pennsylvania Anand Patel, MD Orthopedic Surgeon, Adult Reconstruction Summit Health Florham Park, New Jersey Preetesh D. Patel, MD Staff (Orthopaedic Surgery) Levitetz Department of Orthopaedic Surgery and Rehabilitation Cleveland Clinic Florida Weston, Florida Neil Pathak, MD Department of Orthopaedics and Rehabilitation Yale University New Haven, Connecticut Christopher E. Pelt, MD Associate Professor University Of Utah Health Salt Lake City, Utah Holly Pilson, MD Associate Professor Department of Orthopaedic Surgery and Rehabilitation Wake Forest University School of Medicine Winston-Salem, North Carolina Andrew Poole, MD Orthopedic Chairman, Fort Sanders Tennessee Orthopaedic Clinic Knoxville, Tennessee Amir Pourmoghaddam, PhD Director of Research Memorial Bone and Joint Research Foundation Houston, Texas

Mark J. Powers, MD, FAAOS, FACS Florida Orthopaedic Specialists Clinical Associate Professor Florida State University Tallahassee, Florida Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2024

Department of Orthopaedic Surgery Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire

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