Dedication Acknowledgments About the Editors Contributing Authors Foreword Introduction Section I Basic Direct Anterior Approach Surgical Technique Chapter 1 Applied Anatomy of the Anterior Hip and Thigh Chapter 2 Indications for the Direct Anterior Approach Chapter 3 Managing Single and Multiple Incisions in Direct Anterior Hip Surgery Chapter 4 Primary Total Hip Arthroplasty Using the Hana Table Chapter 5 Extensile Approach to Anterior Hip Surgery Chapter 6 Anterior Supine Intermuscular Total Hip Replacement Chapter 7 Tips and Tricks for Overcoming the Direct Anterior Approach Learning Curve Section II Intermediate Direct Anterior Approach Techniques Chapter 8 Understanding the Risks in New Technologies Chapter 9 Direct Anterior Total Hip Arthroplasty in the Lateral Chapter 10 Direct Anterior Total Hip Replacement With Leg Positioning System and Fluoroscopy Chapter 11 Computer Navigation and Robotics in Anterior Hip Reconstruction Chapter 12 Transitioning to Direct Anterior Total Hip Replacement Chapter 13 Specialized Instruments for the Direct Anterior Approach Chapter 14 Specialized Retraction for Direct Anterior Total Hip Arthroplasty Section III Advanced Adult Reconstructive Techniques Chapter 15 Avoiding, Recognizing, and Treating Complications of the Direct Anterior Hip Approach Chapter 16 How to Identify and Correct Technical Errors With the Direct Anterior Approach Chapter 17 Head and Liner Revision Surgery via the Direct Anterior Approach Chapter 18 Simultaneous Bilateral Direct Anterior Approach Total Hip Arthroplasty Chapter 19 Acetabular Direct Anterior Approach Revision Surgery Chapter 20 Anterior Approach Femoral Revision Surgery Section IV Direct Anterior Approach Across Orthopedic Specialties: Pediatrics Chapter 21 Direct Anterior Hip Surgery in Pediatric Patients Chapter 22 Management of Developmental Dysplasia of the Hip With the Bernese Periacetabular Osteotomy Section V Direct Anterior Approach Across Orthopedic Specialties: Sports/Hip Preservation Chapter 23 Limited Exposure Direct Anterior Approach for Treatment of Femoroacetabular Impingement Chapter 24 Addressing Acetabular and Femoral Lesions in Hip Impingement With the Direct Anterior Approach Section VI Direct Anterior Approach Across Orthopedic Specialties: Trauma Chapter 25 Management of Acetabular Fractures in the Elderly With Direct Anterior Hip Surgery Section VII Direct Anterior Approach Across Orthopedic Specialties: Adult Reconstruction/Hip Preservation Chapter 26 Proximal Femur-Preserving Hip Reconstruction With the Direct Anterior Approach Section VIII Direct Anterior Approach Across Orthopedic Specialties: Oncology Chapter 27 Tumor Reconstruction of Hip and Proximal Femur With the Anterior Approach Section IX Direct Anterior Approach Across Orthopedic Specialties: Rehabilitation Chapter 28 Patient Rehabilitation After Direct Anterior Hip Surgery Section X Direct Anterior Approach Across Orthopedic Specialties: Anesthesia Chapter 29 Anesthesia for the Direct Anterior Approach to Total Hip Arthroplasty Section XI Outcomes Chapter 30 Multi-Center Outcomes Chapter 31 Current Direct Anterior Approach Outcomes Literature Review Chapter 32 Training and Educating Others About Direct Anterior Hip Surgery Chapter 33 Understanding Short Femoral Stem Design and Application in Direct Anterior Approach Total Hip Arthroplasty Section XII Conclusion Chapter 34 In Closing: The Future of Direct Anterior Hip Surgery Financial Disclosures Index
B. Sonny Bal, MD, JD, MBA is an arthroplasty surgeon, who was
one of the early adopters of anterior total hip arthroplasty. Dr.
Bal has an academic appointment at the University of Missouri in
Columbia, Missouri. In addition to clinical work, he is active in
materials science research at the Missouri University of Science &
Technology at Rolla, Missouri, and heads a silicon nitride ceramic
manufacturer located in Salt Lake City, Utah. Dr. Bal is also an
attorney and active in medico-legal education and consulting
work.
Originally from New Jersey, Lee E. Rubin, MD matriculated as an
undergraduate Presidential Scholar at Brandeis University, Waltham,
Massachusetts and graduated Cum Laude in 2000. He then graduated
with Alpha Omega Alpha distinction from the Tufts University School
of Medicine, Boston, Massachusetts in 2004. Dr. Rubin completed his
orthopedic training at Yale University, New Haven, Connecticut in
2009, followed by an Adult Reconstruction Fellowship focused on the
Direct Anterior Approach with Dr. Kristaps J. Keggi and the Keggi
Orthopedic Foundation in Connecticut in 2010.
Dr. Rubin is presently affiliated with University Orthopedics, Inc
and is an Assistant Professor of Orthopedic Surgery on the faculty
of the Warren Alpert Medical School of Brown University in
Providence, Rhode Island. He is actively engaged in numerous
clinical research projects through The Miriam Hospital’s Total
Joint Center, Providence, Rhode Island, and has published over 50
scientific posters, papers, and book chapters. He is a Fellow of
the American Academy of Orthopaedic Surgery (AAOS), a Fellow of the
American Association of Hip and Knee Surgeons (AAHKS) an active
member of the Orthopaedic Research Society (ORS), and is a Faculty
Member of the International Congress for Joint Reconstruction
(ICJR).
In 2013, Dr. Rubin was selected and awarded as one of the Forty
Under 40 in Rhode Island by the Providence Business News. In 2013,
he was elected to serve on the Executive Committee of the Rhode
Island Orthopedic Society (RIOS), and was invited to serve on the
Board of the Yale Orthopaedic Association in 2016. He is an
editorial board member and reviewer for a number of prestigious
orthopedic journals, is actively involved with the Rhode Island
Chapter of the Arthritis Foundation, and was the Chapter’s Medical
Honoree at the Providence Walk to Cure Arthritis event in 2015. He
lives outside of Providence, Rhode Island with his wife and 2
children.
Kristaps J. Keggi, MD, Dr Med (hc) is the Elihu Professor of
Orthopaedics and Rehabilitation at the Yale University School of
Medicine in New Haven, Connecticut. Dr. Keggi was born in Latvia
and arrived in America as a World War II refugee at the age of 15
years. With the exception of 2 years of general surgical training
at the “Old” Roosevelt Hospital in New York City and 2 years of
military service with the United States Army in Texas and Vietnam
(3rd Surgical Hospital, Army, Mobile), Dr. Keggi has been
associated with Yale College and Yale University since 1951. First,
he attended Yale as an undergraduate and medical student, later
trained as a Yale orthopedic resident, and ultimately joined the
teaching faculty of the university, a post he holds to the present
day.
Dr. Keggi completed his orthopedic training in 1964 and was
practicing and teaching orthopedic surgery for more than 5 years
when the Charnley Low Friction Arthroplasty was brought to the
United States. He was among the first in Connecticut to perform
this procedure in its classical transtrochanteric manner. Based on
his training with Wayne O. Southwick, MD, who encouraged innovative
thinking, he rapidly moved to utilize the less traumatic Direct
Anterior Approach. With the help of Terry Light, MD, his resident
at the time, he presented the DAA technique for total hip
arthroplasty (THA) and published his early results as a Scientific
Exhibit at the 1977 Meeting of the AAOS in Las Vegas. Subsequently,
in October of 1980, he published the results in Clinical
Orthopaedics and Related Research, thereby becoming one of the
first American surgeons to publish on the DAA for THA. Continuously
since that era, the DAA has been his primary approach for all
simple and complex hip arthroplasty procedures.
Over the course of a career spanning over 50 years, Dr. Keggi has
improved the lives of thousands of patients, has taught over 150
Yale residents, and has hosted more than 250 international fellows
brought to Yale and The Waterbury Hospital from Latvia, Estonia,
Lithuania, Russia, Ukraine, Georgia, Belarus, Kazakhstan,
Uzbekistan, Tajikistan, Sweden, Germany, and Vietnam. He is the
author of numerous publications on total hip surgery, has lectured
at multiple meetings and locations, and has visited sites around
the world to teach and perform DAA hip replacements.
During his career, Dr. Keggi has received numerous Yale teaching
awards, honorary degrees from Universities around the world, and
has been honored with the Latvian Order of the Three Stars in 1993,
the V Class Order of the Estonian Red Cross in 1999, the
Distinguished Service Medal of the Latvian Physicians Association
(the second ever awarded) in 2009, and the Silver Medal of Medical
Dignity and Service to Russian Medicine in 2012. He was granted
honorary memberships in both the Latvian Academy of Science in 1990
and the Russian Academy of Science in 1993. One of his greatest
honors was to have received the George H.W. Bush Lifetime of
Leadership Award from his alma mater, Yale University, in 2005.
“This is the single best reference for the direct anterior surgical
approach to the hip. The final section of the book is particularly
impressive as it deals with outcomes and evolving implant design
concepts specific to the DAA. It is an essential addition to the
academic orthopedic surgical library.”
-- Samuel J. Chmell, MD, University of Illinois at Chicago College
of Medicine,Doody’s Review Service
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