Elevation of the Femur in THA Through a Direct Anterior Approach: Cadaver and Clinical Studies

Matsuura, Minoru; Ohashi, Hirotsugu; Okamoto, Yusaku; Inori, Fumiaki; Okajima, Yoshiaki

doi:10.1007/s11999-010-1349-x

Cited by 33 publications

(19 citation statements)

References 12 publications

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“…Furthermore, because of the limited surgical visual field in MIS-THA, there is a risk of prolonged operation time, unexpected soft tissue injury, unfavorable implant placement position, and fracture [1]. Anterior elevation of the proximal femur for a clearer visual field and femoral rasping may minimize these complications, and releasing of the posterolateral capsule or superior capsule has been advocated [7,11]. However, such capsular dissection and femoral rasping may pose a risk of damaging the short external rotators.…”

Section: Introductionmentioning

confidence: 99%

Anatomic Mapping of Short External Rotators Shows the Limit of Their Preservation During Total Hip Arthroplasty

Ito

Matsushita

Watanabe

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background The direct anterior approach in THA requires no detachment of muscle insertions. However, damage to the short external rotator muscles may occur when attempting to elevate the femur for exposure. Although the anatomic insertions of these muscles are approximately known, there are no quantitative data regarding their locations. Questions/purposes We therefore asked where and how the tendons attach to the inner aspect of the greater trochanter. Methods In 20 cadaveric hips we identified the attachments of the short external rotator tendons on the medial aspect of the greater trochanter. Mapping of the attachment site was performed by defining coordinate axes; the total width and height of the greater trochanter represented 100% and distances of the attachment from the anteroinferior reference point were given. ResultsThe mean anterior border location of the conjoined tendon (obturator internus, gemellus superior, and gemellus inferior) attachment was located at 29% (13 mm from the anteroinferior reference point), its posterior border at 53% (23 mm), its mean superior border at 70% (15 mm), and its mean inferior border at 24% (5 mm). The mean anterior border of the piriformis tendon attachment was located at 57% (25 mm), its mean posterior border at 78% (34 mm), its mean superior border at 64% (17 mm), and its inferior border at 55% (12 mm). There was considerable variation in these attachment sites among individuals. Conclusions The insertion of the conjoined tendon extends to the anterosuperior aspect of the greater trochanter. Together with the considerable variation of the attachment site, external rotator muscles remain at risk of being damaged during the capsular release.

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Section: Introductionmentioning

confidence: 99%

Anatomic Mapping of Short External Rotators Shows the Limit of Their Preservation During Total Hip Arthroplasty

Ito

Matsushita

Watanabe

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…DAA to hip arthroplasty carries many distinct advantages, which are balanced by difficulties with femoral exposure [5]. Given the technical challenges, a distinct and possibly lengthy learning curve has been well described with regard to surgeons newly adopting the procedure [6,7].…”

Section: Discussionmentioning

confidence: 99%

“Table-less” and “Assistant-less” Direct Anterior Approach to Hip Arthroplasty

et al. 2015

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In recent years, specialized, non-sterile, traction table systems have facilitated Direct Anterior Approach (DAA) hip arthroplasty. To combat the potential downsides of these traction systems, a sterile, intra-operative retractor option has emerged as a means to access the surgical site more easily, minimize soft-tissue trauma, and reduce the degree of required human assistance. This chapter describes the setup, surgical approach, and early results of a retractor system (the Phantom MIS Anterior Hip Retractor system [TeDan Surgical Innovations, Inc. {TSI}, Houston, Texas, US Patent # 8,808,176 B2]), which uses a standard operating table, allows preparation of both lower extremities free in the surgical field, is compatible with fluoroscopy, and aids in both acetabular and femoral exposure, preparation, and implantation. Early outcome data indicates that this system significantly minimizes the need for surgical assistance, while allowing for safe and effective DAA performance, facilitating the procedure for high-volume surgeons and shortening the learning curve for surgeons new to the procedure.

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“…Sequential soft-tissue releases, including continued capsular release and possible release of the obturator internus and piriformis, can be performed to improve mobilization of the femur. Superior capsular release has the greatest impact on the ability to elevate the femur when compared with release of the anterior or posterior capsule or the obturator internus 19 . To minimize the risk of dislocation, the obturator externus must not be violated.…”

Section: Operative Techniquementioning

confidence: 99%