Complications associated with the Direct Anterior Approach in Total Hip Replacement: A Review of the Literature

Aim and background: The direct anterior approach (DAA) to total hip arthroplasty (THA) has gained widespread acceptance due to its ability to facilitate a minimally invasive, muscle-sparing approach, thereby allowing for a rapid restoration of function.However, this technique introduces a distinct complication profile that differs from the posterior and lateral approaches.This narrative review synthesizes the current literature (2010-2025) to characterize the complications associated with DAA-THA, identify risk factors, and synthesize mitigation strategies.Materials and methods: A comprehensive search on PubMed, MEDLINE, and Google Scholar identified published reviews, meta-analyses, randomized trials, and registry studies.Results: Key findings show: (i) DAA facilitates improved early functional recovery and reduced dislocation rates in obese patients; (ii) increased complication rates in specific areas-lateral femoral nerve (LFCN) dysfunction, early periprosthetic fracture and surgical site complications, by the systematic use of standardized protocols and careful patient selection; The most frequently reported complications are transient LFCN sensory impairment (2-5%), intraoperative femoral fracture (4.2% in the first 25 cases, decreasing to 0.9% after 100 cases) and wound complications (adjusted hazard ratio 2.4, 95 confidence interval (CI) 1.6-3.7).Experience as a surgeon has a significant effect on outcomes-complication rates drop from a reference value of 0.22 (95% CI) to 0.34 (for surgeons with 100 cumulative cases).Conclusion: Evidence-based mitigation strategies include selective enrolment of patients, structured mentoring programs, intraoperative fluoroscopy, and protocolized wound care.Future research should give priority to prospective multi-center studies with standardized outcome definitions, cost-benefit analysis, and evaluation of new technologies.Clinical significance: Clinicians using direct anterior management must weigh the functional benefits against the distinct complication profiles through individual patient selection, structured training pathways, and systematic monitoring of the outcome.