{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T14:12:58Z","timestamp":1778767978409,"version":"3.51.4"},"reference-count":42,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,6,9]],"date-time":"2023-06-09T00:00:00Z","timestamp":1686268800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Wuerzburg"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: The direct anterior approach (DAA) represents a well-recognized soft tissue sparing technique for primary total hip arthroplasty (THA). The feasibility and suitability of the DAA in cases of complex acetabular deformities, namely coxa profunda (CP) and protrusio acetabuli (PA), remain to be determined. Methods: A total of 188 cases of CP (100 cases) and PA (88 cases) hips undergoing primary THA via the DAA were retrospectively analyzed. Surgical and radiographic parameters were evaluated and potential complications were assessed. Finally, successful implantation was defined if surgical and radiographic parameters were well within established values of non-complex primary THA. Results: In 159 hips, the medial border of the acetabular component was transferred laterally to the ilioischial line, corresponding to a fully treated acetabular protrusion. In 23 (12.23%) cases, mild, and in 5 (2.66%) cases, moderate residual acetabular protrusion remained after THA. Postoperatively, 11.40% (PA group) and 9.00% (CP group) had a leg length discrepancy (LLD) greater than 10 mm. The mean operative time was significantly less than 60 min. A linear relationship between the BMI and operative time was observed, with an additional 0.9 min of operative time per BMI unit. Overall, complications were rare and did not differ between the two groups. Conclusion: The results of this study suggest that the DAA is a suitable approach for primary THA in patients with coxa profunda and acetabular protrusion if performed by experienced surgeons familiar with the DAA. Obese patients with acetabular protrusion may pose a significant limitation to the DAA and caution should be advised in cases of obesity.<\/jats:p>","DOI":"10.3390\/jcm12123941","type":"journal-article","created":{"date-parts":[[2023,6,9]],"date-time":"2023-06-09T02:59:57Z","timestamp":1686279597000},"page":"3941","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["The Direct Anterior Approach (DAA) as a Standard Approach for Total Hip Arthroplasty (THA) in Coxa Profunda and Protrusio Acetabuli? A Radiographic Analysis of 188 Cases"],"prefix":"10.3390","volume":"12","author":[{"given":"Tizian","family":"Heinz","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hristo","family":"Vasilev","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip Mark","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5522-0092","authenticated-orcid":false,"given":"Ioannis","family":"Stratos","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9362-2914","authenticated-orcid":false,"given":"Axel","family":"Jakuscheit","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9086-3541","authenticated-orcid":false,"given":"Konstantin","family":"Horas","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boris Michael","family":"Holzapfel","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Marchioninistr 15, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4982-6594","authenticated-orcid":false,"given":"Maximilian","family":"Rudert","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3551-3204","authenticated-orcid":false,"given":"Manuel","family":"Wei\u00dfenberger","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"487","DOI":"10.2106\/00004623-200004000-00004","article-title":"Charnley total hip arthroplasty with cement: Minimum twenty-five-year follow-up","volume":"82","author":"Callaghan","year":"2000","journal-title":"Jbjs"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s42836-019-0007-3","article-title":"Patient satisfaction and total hip arthroplasty: A review","volume":"1","author":"Okafor","year":"2019","journal-title":"Arthroplasty"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.1016\/S0140-6736(07)60457-7","article-title":"The operation of the century: Total hip replacement","volume":"370","author":"Learmonth","year":"2007","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1016\/S0140-6736(61)92063-3","article-title":"Arthroplasty of the hip: A new operation","volume":"277","author":"Charnley","year":"1961","journal-title":"Lancet"},{"key":"ref_5","first-page":"227","article-title":"Direct anterior total hip arthroplasty","volume":"63","author":"Unger","year":"2014","journal-title":"Instr. 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