Direct anterior approach in total hip arthroplasty: a narrative review

Objective: Worldwide, a growing number of Total Hip Arthroplasty (THA) procedures are being performed each year. However, despite this significant global demand, the ideal surgical approach remains controversial. Globally there has been a significant increase in the use of direct anterior approach THA. Therefore, the objective of this paper was to synthesise the vast body of new, evolving information into one non-biased narrative review, to provide an overarching review of various aspects of this approach, including controversial issues such as, benefits, functional outcomes, complications, costs, and surgical technique. Data source: The following keywords were entered into various scientific databases including, Mbase, Google scholar and PubMed. Only articles published in journals between 2017 and 2021 were extracted and included in this review. We found 148 articles published during this period and we used the 82 most relevant articles to collate this narrative review. Data selection/ extraction: Three fellowship trained arthroplasty orthopaedic surgeons, (JRTP, LM and JC) went through all the papers and selected the 82 most relevant papers for inclusion in this review. Conclusion: There has been significant interest and renewed vaguer in publication rates by authors worldwide evaluating the use of the DAA in THA. Most recent studies show that there is increasing evidence that the DAA is a safe, reliable, and reproducible surgical approach to THA. Direct anterior approach provides, in the most part, superior early short term functional outcomes in comparison with other THA approaches. It has however also been shown that a steep learning curve exists when using this approach. While complication rates are similar to those seen in other approaches, the types of complications however remain slightly different with an increase incidence of intraoperative peri-prosthetic femoral fractures, wound complications and femoral stem aseptic loosening being significantly greater in the direct anterior approach

Effect of temperature and rainfall on the distribution of the South African shelduck Tadorna cana

The distribution of the South African shelduck Tadorna cana was mapped and related to temperature and rainfall. A multiple regression analysis based on quantified spatial abundance (the number of sixteenth degree squares recorded with shelduck in a degree square), mean annual rainfall, mean annual temperature and mean temperature of the coldest (July) and hottest (January) months indicated a significant (P < 0,001) negative linear relation between shelduck distribution and temperature, but no significant (P > 0,05) relation with rainfall. Mean annual rainfall in excess of 600 mm is however suggested to bring about unfavourable habitat within temperate southern Africa. The hypotheses formulated on the environmental relations of shelduck distribution are compared with habitat preference, breeding season, nest sites and feeding behaviour