Acetabular Orientation: Anterolateral Approach in the Supine Position

Abstract

The anterolateral approach in the supine position provides excellent visualization of the acetabulum. The main advantage of the approach, a low dislocation rate, has been demonstrated in the literature, while the purported disadvantage of abductor dysfunction has not been clearly delineated in the literature. The technique requires meticulous attention to preservation of the gluteus medius and minimus tendons. Impingement and dislocation are avoided by careful attention to the preparation of acetabulum, critical assessment of the implanted components, and intraoperative trialing. Leg lengths are assessed through direct palpation of the malleoli. Routine use of postoperative hip precautions is not necessary when this approach is utilized. The anterolateral approach in the supine position allows for a reproducible result with a low dislocation rate. Level of Evidence: Level V, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Is the cup orientation different in bilateral total hip arthroplasty with right-handed surgeons using posterolateral approach?

“…They found that acetabular cup orientation showed no significant differences between the three surgical approaches. Rothman [ 19 ] thought that the operative approach affects the planned orientation of the acetabulum, primarily anteversion. Further research is needed.…”

An In Vivo Comparison of the Orientation of the Transverse Acetabular Ligament and the Acetabulum

“…Techniques for alignment of the acetabular cup remain controversial [44]. The ideal inclination and anteversion in THA are different for every patient [19]. Although Lewinnek's 'safe zone' is the most well known, others have suggested alternative and tighter limits [7,32,45].…”

“…Although post-operative dislocation rates have been reported to be as high as 2%-11% [7,[15][16][17] the most recent Australian data suggest a rate of less than 1% [18]. Correct positioning of the acetabular cup has also been reported to be an important factor in preventing component wear after THA [5,12,14,15,[19][20][21][22][23][24][25][26][27][28][29][30].…”

Prospective Short-Term and Return-to-Sports Results of a Novel Uncemented Short-Stem Hip Prosthesis with Metaphyseal Anchorage

“…The patient is placed in supine position. The minimally invasive Watson-Jones approach is utilized for reduced soft-tissue damage [16]. The capsule is split but not resected.…”