How the anterior hip replacement approach fuels outpatient surgery, value-based care

Joel Matta, MD, pioneered the anterior approach for total hip replacement in the United States in 1996, is an orthopedic surgeon specializing in hip disorders at The Steadman Clinic in Vail, Colo., and the co-founder and chairman of the Anterior Hip Foundation.

Scott Zellner is senior director of U.S. joint reconstruction and outpatient marketing at DePuy Synthes. They discuss DePuy Synthes' recently launched program for Anterior Approach called Anterior Advantage Matta Method.

Question: How does Anterior Advantage Matta Method compare with traditional approaches to hip replacement?

Dr. Joel Matta: Total hip arthroplasty with the Anterior Advantage Matta Method uses a muscle sparing surgical technique that studies show is associated with less pain, faster recovery and a reduced hospital stay versus traditional approaches. A recently published study showed a cost savings of $6,200 per patient ($17,763 with Anterior Advantage Matta Method vs. $23,969 compared to the cohort.)*

Scott Zellner: This method formalizes a prescribed surgical technique which uses tools like the Hana Table and intra-operative imaging that enhances the surgeon's ability to perform the procedure and reduces variability in how the hip joint is exposed throughout the procedure. It is part of DePuy Synthes' comprehensive solution for Anterior Approach hip replacement that includes the company's primary and revision hip implant products, instrumentation, enabling technologies and world-class professional education designed to help decrease the learning curve and increase OR efficiency and surgical reproducibility with the goal of delivering better patient outcomes.

Q: How does Anterior Advantage address the learning curve associated with Anterior Approach?

SZ: As with any surgical approach, there is a learning curve associated with the Anterior Approach, which varies by surgeon. Over the last 15 years, DePuy Synthes has developed best practices for learning in collaboration with Dr. Matta. We have facilitated the training of thousands of surgeons and our courses are taught exclusively by Dr. Matta and highly experienced DePuy Synthes consulting surgeons at various learning stages for Primary, Advanced (+25 cases) and Revision (+100 cases).

Our educational philosophy is to connect world class education, training and experiential learning on Anterior Approach to innovative implants and technologies that enhance the procedure, reduce variability and improve clinical and economic outcomes.

Q: What has led to the rapid growth of Anterior Approach in the U.S.?

JM: Patient satisfaction has been the main driver of Anterior Approach and as word of successful patient outcomes has spread, more and more orthopaedic surgeons have adopted the procedure. Patients are requesting it.

SZ: Since 2004, there has been a steady rise in the number of surgeons performing Anterior Approach. According to a survey conducted at the 2018 AAHKS meeting, nearly 40 percent of surgeons surveyed are performing Anterior Approach today. And as high deductible health plans and higher co-pays lead patients to be smarter consumers and with the rapid rise in aging Baby Boomers, the trend towards the Anterior Approach is expected to grow even more.

Q: Can surgeons perform the Anterior Approach outpatient?

SZ: Yes, we are seeing more and more Anterior Approach procedures performed in an outpatient setting and this is a trend that will continue. In fact, last year we published our first case study with the Buffalo Surgery Center which highlighted improved outcomes and patient experience, and reduced costs when performing hip replacement surgery with Anterior Approach in an ASC. Becker's ASC Review published a bylined article focusing on how we believe ASCs will continue to grow in the total joints setting and showcases this study as an example of the benefits of Anterior Approach in the ASC.

JM: One of the fastest growing segments in orthopedics today is outpatient surgery, and with the faster recovery and less pain patients experience, Anterior Approach is a natural fit for this setting.

One of the most important aspects is that it allows the entire surgical care episode to be directed primarily by the orthopedic surgeon, with a minimization of administration and complexity of care that can occur in other sites of care. The ASC is focused on the essential care, giving professionals parameters that enhance quality and efficiency. Patients are in a user-friendly environment and can minimize their time in the health care facility. There is data to demonstrate the safety and efficacy of outpatient THA.1,2

Q: How does the Anterior Approach fit into the physician's need to provide high-value treatment for their patients?

SZ: Our healthcare system continues its move from volume to value, and physicians are getting measured not only on great clinical outcomes, which both the traditional and the Anterior Approach can deliver, but also on the overall patient experience and reduction of the overall cost of care. Anterior Approach has been shown to improve patient satisfaction and reduce costs, so this procedure is of high value to patients, physicians and health systems.

Q: What do you see for Anterior Approach over the next 5 to 10 years in terms of refinements to the technique and advances in technology?

JM: I believe Anterior Approach will be the way of the future for hip replacement. We will certainly continue to refine the technique to develop new technologies that improve imaging and accuracy, reproducibility of outcomes and procedural efficiencies.

SZ: Since 2004, DePuy Synthes has introduced multiple advancements for Anterior Approach. More recently, the Actis Total Hip System was designed and launched for muscle sparing approaches. Our Kincise Surgical Automated System delivers a consistent application of energy to automate bone preparation, implant assembly and positioning. Our co-marketing agreement with JointPoint Navigation Software offers digital templating, case planning, and intraoperative analysis solutions for Anterior Advantage total hip replacement surgery.

We will continue to innovate product, technique, technology, and evidence aimed at delivering improved clinical outcomes, increased patient and surgeon satisfaction, reduced economic burden and increased overall efficiencies within the healthcare system.

For more information, visit
*ANTERIOR ADVANTAGE™ MATTA METHOD™ claims are made in comparison to other traditional approaches.

1 Berend KR,; Lombardi AV Jr,; Berend ME, Adams JB,; Morris MJ “The outpatient total hip arthroplasty: a paradigm change”. Bone Joint J. 2018 Jan;100-B (1 Supple A):31-35. doi: 10.1302/0301-620X.100B1.BJJ-2017-0514.R1.
2 Lombardi AV Jr1, Barrington JW, Berend KR, Berend ME, Dorr LD, Hamilton W, Hurst JM, Morris MJ, Scuderi GR. “Outpatient Arthroplasty is Here Now”. Instructor Course Lecture 2016;65:531-46.

More articles on orthopedics:
Dr. Andrew Koman honored with orthopedic award
Challenges, opportunities and bundled payments in orthopedics
Dr. Richard Berger becomes 1st US physician to perform 10,000 outpatient joint replacements

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