Though DAA is commonly performed on a traction table or with an adjustable traction attachment, there is growing interest in the perioperative and economic advantages of DAA technique on a standard OR table2.
Dr. Andrew Battenberg has found that the off-table approach can be more efficient and less costly than traction tables. Using a standard OR table with a foam-based, pre-contoured tabletop positioner, enables a surgeon to establish a reproducible pelvic position, stabilize the pelvis for dislocation and relocation, ensure femoral exposure on the operative side, and use intra-op fluoroscopy as needed.
A Cost Effective and Efficient Approach to Off-Table DA Hip Surgery
Considering healthcare’s chronic staffing shortages and pressure to control costs, efficient, cost-effective solutions are needed. Transitioning from an “on-table” to an “off-table” technique for THA via the DAA is associated with substantial improvements in operative and perioperative efficiency. After adjusting for a learning curve, the mean surgical time improved by 28 minutes (23.11%) and total room time by 43 minutes (23.37%), which allowed for an additional case per room per day2.
Andrew Battenberg, MD
Dr. Battenberg is Chief of Orthopedics at Kaiser Vacaville Medical Center. He specializes in direct anterior hip arthroplasty using minimally invasive techniques; most of his cases are primary DAA. He received his medical degree from UCLA, completed his orthopedic surgical residency at Harbor-UCLA Medical Center, and followed with an Adult Reconstruction fellowship at the Rothman Institute in Philadelphia, Pennsylvania.
Download the technique guide:
A Step-by-Step Guide to the DAA technique using the BoneFoam DAA Positioner
Positioning the pelvis is critical to success in using the Direct Anterior Positioning System.
See how OR workflow is simplified, and learn key features of the system that help to improve femoral exposure.
The surgeon has complete control of the operative extremity.
Adduction is the key to optimizing femoral exposure, not extension.
See how using a slight Trendelenberg position increases femoral extension and exposure.
1. J. A. Singh, S. Yu, L. Chen and J. D. Cleveland, "Rates of Total Joint Replacement in the United States Using the National Inpatient Sample," Journal of Rheumatology, 2019.
2. Owen TM, Horberg JV, Corten K, Moskal JT. “The Off-Table Technique Increases Operating Room Efficiency in Direct Anterior Hip Replacement,” Arthroplast Today, vol. 15, pp. 167-173, 2022.