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Current & Critical

Surgeon Insight: The Future of the Anterior Approach in Hip Replacement

By Carolyn LaWell

In 1Q19, DePuy Synthes announced the Anterior Advantage Matta Method, a defined surgical technique combined with tools such as orthopedic tables and intraoperative imaging. The namesake of the program, Joel Matta, M.D., is a surgeon at The Steadman Clinic, Co-founder and Chairman of the Anterior Hip Foundation and a pioneer of the anterior approach.

Dr. Matta began using the anterior approach in the late ‘90s and has remained dedicated to the technique, noting that it results in tissue preservation and shorter recovery time. More than two decades later, he remains committed to teaching and advancing the anterior approach. We spoke with him at AAOS about what’s still to come with anterior hip replacement.

What improvements need to be made for greater adoption of the anterior approach?

While progress has been made over the last decade and a half, Dr. Matta noted that the procedure needs to be more repeatable, resulting in less chance for error and complications and ease of adoption by high- and low-volume surgeons. That means not only proper teaching of the technique, but also using the right tools. Dr. Matta and DePuy Synthes have partnered on a full solution, including implants, instruments and enabling technology like JointPoint.

“If we look back at orthopedics and ask how is hip surgery going to be done right, at the beginning, the emphasis was on the implant. The different companies and surgeon designers were saying, ‘We've designed this implant, it’s the best implant; you put in this femoral and acetabular implant and the patient is going to do great,' ” Dr Matta said. “I think the concept now is that you need a package of a number of techniques and technologies. You can’t just ignore one of them.”

What is the growth potential of the direct anterior approach?

As more hip replacements move to outpatient or ambulatory surgery center settings, the anterior approach is likely to increase due to the quicker recovery time, says Scott Zellner, Senior Director of U.S. Joint Reconstruction and Outpatient Marketing at DePuy Synthes.

DePuy Synthes points to research that states that more than 40% of hip replacement surgeons currently use the anterior approach, a growth of 6% since 2016. Dr. Matta has noticed an increasing number of fellows and residents choosing the anterior approach over the posterior.

“I think it's just about reaching a tipping point where most hips in the U.S. will be done with the anterior approach,” Dr. Matta says. “I believe the number of patients getting the anterior approach is more important than the number of surgeons doing it. I think a higher percentage of patients are getting the anterior approach than the percentage of surgeons doing it, because patients are seeking it out now.”

Carolyn LaWell is Chief Content Officer at ORTHOWORLD.