J. Bohannon Mason

The adoption and utilization of the direct anterior approach (DAA) for total hip arthroplasty (THA) has increased significantly over the past decade. This review presents the available literature for early recovery and outcomes of the DAA THA. A growing body of evidence points towards superior early recovery and early functional outcomes with the DAA in experienced hands compared to posterior and lateral based approaches in regards to pain, opioid use, length of stay, and early markers of mobility. In an era of rapid recovery protocols, the DAA with its early pain and functional advantages can effectively deliver safe and effective value for the total hip population.

We conducted a randomized controlled trial to compare efficacy of an occlusive antimicrobial barrier dressing and a standard surgical dressing in patients who underwent primary total joint arthroplasty. Two hundred sixty-two patients were randomized to receive either an occlusive dressing or a standard dressing. Wounds were closed in identical fashion. Outcomes included wound complications, dressing changes, and patient satisfaction. With use of occlusive dressing (vs standard dressing), wound complications (including skin blistering) were significantly (P = 0.15) reduced; there were significantly (P < .0001) fewer dressing changes; and patient satisfaction was significantly (P < .0001) higher. Use of occlusive dressings can reduce wound complications and promote wound healing after total joint arthroplasty.

The number of total knee arthroplasties (TKAs) performed annually in the United States is increasing exponentially. Even with modest annual revision rates, the number of patients requiring revision knee surgery will increase in a similar fashion. It is therefore important to have a systematic approach dealing with a patient presenting with a painful TKA. The treating physician must be able to recognize a variety of failure patterns and treat them accordingly. Surgical exploration in the absence of a definable cause is rarely successful and should be avoided. The ability to plan and execute a complex revision TKA is a challenging and rewarding aspect of adult reconstructive surgery. Commonly encountered mechanisms of failure are identified and a stepwise approach to the surgical management of these conditions is presented.