The Anatomic-Atraumatic-Anterior Reconstructive Technique (A-A-ART) for total hip arthroplasty: A step-by-step pictorial guide to a minimally invasive approach for hip osteoarthritis

Total hip arthroplasty remains one of the most successful orthopedic procedures for the treatment of hip osteoarthritis. Among contemporary surgical approaches, the direct anterior approach has gained increasing popularity due to its intermuscular and internervous plane, which aims to minimize soft-tissue trauma and potentially reduce instability. This article provides a step-by-step pictorial overview of the Anatomic-Atraumatic-Anterior Reconstructive Technique (A-A-ART) performed without a traction table and combined with dual-mobility articulation. Key technical steps are described, including patient positioning, capsular management, acetabular preparation using anatomical landmarks, controlled femoral exposure, and implant positioning. Particular emphasis is placed on progressive capsular release, protection of the anterior acetabular horn, and prevention of varus stem alignment. When performed in a standardized and reproducible manner, the A-A-ART technique allows reliable limb length control, stable component orientation, and preservation of periarticular structures, offering a safe and effective strategy for the surgical management of hip osteoarthritis.