Total Hip Arthroplasty: Contemporary Surgical Approaches, Navigation Technology and Determinant Factors of Clinical Outcomes. A Narrative Review

Background and Objective: Total hip arthroplasty (THA) represents one of the most successful orthopedic interventions for treating degenerative and traumatic hip pathologies. This narrative review aims to critically analyze current evidence regarding contemporary surgical approaches in THA, the role of computer-assisted technology, and determinant factors influencing clinical outcomes. Methods: A comprehensive narrative literature review was conducted covering publications from 2010 to 2025 across PubMed, Scopus, SciELO, SpringerLink, and Google Scholar databases. Inclusion criteria comprised studies with sample sizes ≥30 patients, functional assessment using validated scales (Harris Hip Score, WOMAC, SF-36), and minimum three-month follow-up. Original articles, systematic reviews, meta-analyses, randomized controlled trials, and academic theses in English or Spanish were included. Results: Minimally invasive approaches including SuperPATH (Supercapsular Percutaneous Assisted Total Hip) and direct anterior approach (DAA) demonstrate significant advantages over traditional posterior approach, including reduced intraoperative bleeding, decreased postoperative pain, and accelerated functional recovery. Meta-analyses involving over 1,500 patients confirm SuperPATH superiority in terms of blood loss reduction, shorter hospital stays, and lower dislocation rates. Intraoperative navigation technology improves acetabular component positioning accuracy, with up to 98% of implants placed within optimal anteversion and abduction ranges (15°-25° anteversion, 40°-45° abduction). Institutional surgical volume emerges as a critical determinant factor, with high-volume centers (>100 annual procedures) reporting significantly lower complication rates, reduced mortality, and improved functional outcomes. Conclusions: Contemporary THA has evolved toward less invasive techniques with enhanced technological integration. The combination of minimally invasive surgical approaches, computer-assisted navigation, and centralization in high-experience centers represents the current trend for optimizing clinical and functional outcomes. Future directions include greater integration of robotic technology, advanced navigation systems, and personalized treatment approaches based on detailed preoperative analysis and three-dimensional modeling.