Overview

For more than a decade, DePuy Synthes has led the adoption and expansion of the Anterior Approach, a growing, muscle sparing technique in total hip arthroplasty in the U.S. and around the world. The technique has been growing in adoption in the U.S. and around the world. Increasing clinical evidence shows that the Anterior Approach achieves improved outcomes,1 decreased costs2 and less pain3 which may improve patient satisfaction.

As an industry leader in Anterior Approach, DePuy Synthes launches ANTERIOR ADVANTAGE™, a differentiated solution for Anterior Approach, inclusive of DePuy Synthes primary and revision hip implant products, instrumentation, enabling technologies, and world class professional education designed to help decrease the learning curve and increase OR efficiencies and surgical reproducibility for better patient outcomes.

We continue to work closely with thought leaders around the globe to deliver world class Anterior Approach training and education, products, and enabling technologies to surgeons, patients and hospital teams worldwide.

ANTERIOR ADVANTAGE™ Hip Replacement Solution

ANTERIOR ADVANTAGE™ utilizes DePuy Synthes primary and revision hip implant products and may be performed using a Standard OR table, Hana™, or other Orthopaedic table.

DePuy Synthes Primary and Revision Hip Implants

DePuy Synthes works with internationally recognized thought leaders who have helped create and support a strong primary and revision hip implant portfolio. The CORAIL® Hip System and PINNACLE® Acetabular Cup System continue to demonstrate positive patient outcomes and survivorship year after year.4-6 DePuy Synthes products suitable for the approach include, but are not limited to:

CORAIL® Hip System

CORAIL® Hip System has over 30 years of clinical heritage and demonstrates 93.7% Stem Survivorship at 30 Years.4 It is the most widely used primary hip stem construct with the PINNACLE Acetabular Cup System in the NJR.5 CORAIL Stems are offered in a variety of sizes to treat both primary and revision cases.

PINNACLE® Acetabular Cup System

PINNACLE® Acetabular Cup System has been provided to over 3 million patients worldwide since its introduction, across 15 years of clinical heritage.6 PINNACLE Acetabular Cups are offered in a variety of styles to treat both primary and revision cases.

ACTIS™ Total Hip System

ACTIS™ Total Hip System was designed for use in tissue sparing approaches like the Anterior Approach (although it can be used with traditional approaches) and demonstrates enhanced initial stability compared to collarless stems.7,8

Professional Education

DePuy Synthes develops and executes comprehensive ANTERIOR ADVANTAGE™ curriculum to help Surgeons, Physicians Assistants, and other OR Staff specialists, which is designed to decrease the learning curve associated with the Anterior Approach. Attendees are offered a continuum of education and training through their learning journey and adoption of the technique which helps to provide a reproducible result for their patients, while helping maintain surgeon confidence through the educational pathway.

Positive Outcomes vs. Other Approaches

ANTERIOR ADVANTAGE™ uses a muscle sparing surgical technique and is associated with less pain,9-11 faster recovery2,10,11 and reduced length of stay2,10,12 vs. traditional approaches. ANTERIOR ADVANTAGE™ also shows cost reduction2,12 vs. traditional approaches.

Less Pain Than Those Treated with Traditional Approaches

When compared to posterior approach patients, ANTERIOR ADVANTAGE™ patients have reported less pain at day one12 week two,9 and week six postoperatively.9,11

ANTERIOR ADVANTAGE™ patients had better pain scores at six weeks (40 vs. 36, p<0.0001) and six months compared to antero-lateral approach patients.11

ANTERIOR ADVANTAGE™ patients experienced significantly less pain after primary THA as measured by visual analog pain scores (VAS, 4.8 vs 5.9, p<0.001) than posterior approach patients.10

Faster Recovery

ANTERIOR ADVANTAGE™ patients experienced a quicker return to activities of daily living with reduced length of stay,2,9,10,12,13 quicker cessation of walking aids,9,11 higher likelihood to be discharged home,2,13 reduced narcotics consumption,9,12,13,14 ambulating farther after surgery,10,11 and less pain.9,10,11

ANTERIOR ADVANTAGE™ patients were 5 times more likely to cease use of a walking aid by 6 weeks than posterior approach patients.9

ANTERIOR ADVANTAGE™ subjects walked farther post-operatively, and on days 2 and 3, compared to posterior approach patients.10

ANTERIOR ADVANTAGE™ patients had improved ambulation, stair climbing, and ability to put on socks and shoes at 6 weeks and six months follow-up compared to anterolateral patients.11

In a study of Medicare claims data nearly 20% more ANTERIOR ADVANTAGE™ patients were discharged home compared to all other THA approaches (87.3% vs 68.7%, p<0.0001).2


Less Pain Medication

Compared to posterior approach patients, ANTERIOR ADVANTAGE™ patients consume less narcotics in the first three days after surgery13 and are less likely to be using narcotics for pain control at 2 and 6 weeks follow-up.9

Reduced Length of Stay

ANTERIOR ADVANTAGE™ patients were discharged almost one day sooner than patients with posterior approach (2.28 days vs 3.02 days, p=0.0028).10

Reduced Risk of Dislocation

ANTERIOR ADVANTAGE™ is a defined solution for Anterior Approach, a muscle sparing technique. The Anterior Approach is associated with lower risk of dislocation compared to the posterior approach.1,14

Target Component Positioning

Compared to posterior approach patients, ANTERIOR ADVANTAGE™ is a defined solution for Anterior Approach, which may include the use of fluoroscopy for intraoperative images. Component positioning using intraoperative image check with the anterior approach is more accurate than positioning with the posterior approach without intra-operative check.15,16

Reducing the Cost of Care

THA with the ANTERIOR ADVANTAGE™ resulted in 45% cost reduction at 90-days post-operative ($4,139 vs $7,465).2

ANTERIOR ADVANTAGE™ patients averaged a shorter hospital stay (34 hours) vs. posterior approach patients (66 hours) and lateral patients (64 hours). Hospital costs were reduced by 7% on each ANTERIOR ADVANTAGE™ case when compared to lateral cases and 12% when compared to posterior cases ($7,300.22 vs $8,287, p<0.001).12

References

  1. Higgins BT, et al. 2018. JOA. “Anterior vs. posterior approach for THA, a systematic review and meta-analysis.” The Journal of Arthroplasty 2015; (30): 419–434.
  2. Kamath A, Chitnis A, Holy C, et al. Medical resource utilization and costs for total hip arthroplasty: benchmarking an anterior approach technique in the Medicare population. J Med Econ. 2017; 1–7.
  3. Miller LE, Gondusky JS, Bhattacharyya S, Kamath AK, Boettner F, Wright J. Does Surgical Approach Affect Outcomes in Total Hip Arthroplasty Through 90 Days of Follow-Up? A Systematic Review With Meta-Analysis. J Arthroplasty. 2017: 33(4); 1296–1302.
  4. Jacquot L, Bonnin MP, Machenaud A, Choteau J, Saffarini M, Vidalain JP. Clinical and Radiographic Outcomes at 25–30 Years of a Hip Stem Fully Coated With Hydroxyapatite. J Arthroplasty. 2018 Feb;33(2):482–490.
  5. NJR National Joint Registry for England, Wales, Northern Ireland and the Isle of Man, 15th Annual Report, 2018. Table 3.9. Available from www.njrreports.org.uk.
  6. TSM Report, PINNACLE WW implantations YTD, 2001 - 2017. CONFIDENTIAL. FOR INTERNAL USE ONLY. NOT FOR USE WITH ANY CUSTOMER OR FOR EXTERNAL DISTRIBUTION.
  7. Demey G, Fary C, Lustig S, et. al. “Does a Collar Improve the Immediate Stability of Uncemented Femoral Hip Stems in Total Hip Arthroplasty? A Bilateral Comparative Cadaver Study.” JOA. 2011; 26(8): 1549–1555.
  8. Hamburg University Actis Cadaveric Stability Testing. Data on File (Adaptiv #103156243).
  9. Zawadsky MW, et al. “Early Outcome Comparison Between the Direct Anterior Approach and the Mini-Incision Posterior Approach for Primary Total Hip Arthroplasty: 150 Consecutive Cases.” The Journal of Arthroplasty 2014; (29): 1256–1260.
  10. Barrett WP, et al. “Prospective Randomized Study of Direct Anterior vs Postero-Lateral Approach for Total Hip Arthroplasty.” The Journal of Arthroplasty 2013; (28): 1634–1638.
  11. Bourne MH, et al. “A comparison between direct anterior surgery of the hip (DASH) and the anterolateral (AL) surgical approach to THA: Postoperative outcomes.” 2010 AAOS New Orleans, LA, Poster #014.
  12. Petis SM, et al. “In Hospital Cost Analysis of THA: Does Surgical Approach Matter?” The Journal of Arthroplasty 2016; (31)” 53–58.
  13. Schweppe et al. Does Surgical Approach in Total Hip Arthroplasty Affect Rehabilitation, Discharge Disposition, and Readmission Rate? Surgical Technology International XXIII. 2013. Orthopedic Surgery, 219–227.
  14. Miller LE, Gondusky JS, Kamath AT, Boettner F, Wright J, Bhattacharyya S. Influence of Surgical Approach on Long-Term Complication Risk in Primary Total Hip Arthroplasty: Systematic Review and Meta-analysis. Acta Orthopaedica. 2018; 89: 1–7.
  15. Boettner F, Zingg M, Emara A, et al. The Accuracy of Acetabular Component Positioning Using a Novel Method to Determine Anteversion. JoA. 2017; (32): 1180–1185.
  16. Rathod PA, et al. “Does fluoroscopy with anterior hip arthroplasty decrease acetabular cup variability compared with a nonguided posterior approach?” Clin Orthop Relat Res 2012; (472): 1877–1885.