Single-incision Anterior Approach for Total Hip Arthroplasty on an Orthopaedic Table

Matta, Joel M.; Shahrdar, Cambize; Ferguson, Tania A.

doi:10.1097/01.blo.0000194309.70518.cb

Cited by 585 publications

(487 citation statements)

References 23 publications

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“…The anterolateral (AL), or Rottinger, approach, as with the DL approach, allows for maintenance of posterior capsular attachments and short external rotators, which reduces postoperative instability while maintaining abductor integrity [10][11][12]. However, anterior approaches to the hip, possibly including the AL approach, have been associated with increased rates of lateral femoral cutaneous nerve injury [13] and fractures of the greater trochanter and femur [14,15].…”

Section: Introductionmentioning

confidence: 99%

Total Hip Arthroplasty Surgical Approach Does Not Alter Postoperative Gait Mechanics One Year After Surgery

Queen

Appleton

Butler

et al. 2013

PM&R

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Objective: To investigate the differences in gait biomechanics on the basis of surgical approach 1 year after surgery. Design: This was a descriptive laboratory study to investigate the side-to-side differences in walking mechanics at a self-selected walking speed as well as a functional assessment 1 year after total hip arthroplasty (THA). Temporospatial, kinetic, and kinematic data as well as functional outcomes were collected. Two-way analysis of variance was used to assess for between-group differences and limb-to-limb asymmetries. Setting: A controlled laboratory study. Participants: This study examined 35 patients with primary, unilateral THA. The THA surgical approaches that were used in these patients included 12 direct lateral, 18 posterior, and 11 anterolateral. All the patients were assessed 1 year after THA. Patients were excluded from the study if they had contralateral hip pain or pathology, or any prior lower extremity total joint replacements. Main Outcome Measurements: Three-dimensional lower extremity kinematics and kinetics as well as spatiotemporal variables were collected. In addition, a series of physical performance measures were collected. Results: No main effects for the physical performance measures or biomechanical variables were observed among the approach groups. Significant limb-to-limb asymmetries were observed among all the patients, with decreased sagittal plane range of motion, peak extension, and peak vertical ground reaction forces on the operative side. Conclusion:The results of this study indicated that no significant differences existed among the different surgical approach groups for any study variable. However, 1 year after THA, the patients demonstrated asymmetric gait patterns regardless of surgical approach, which indicated the potential need for continued intervention through physical therapy to regain normal side-to-side symmetry after THA.

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Section: Introductionmentioning

confidence: 99%

Total Hip Arthroplasty Surgical Approach Does Not Alter Postoperative Gait Mechanics One Year After Surgery

Queen

Appleton

Butler

et al. 2013

PM&R

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“…Among the MIS-THA methods, the direct anterior approach (DAA) was modified from the Smith-Petersen approach and has become one of the standard procedures for primary THA [5,13]. The DAA, which uses an intermuscular plane among the sartorius, rectus femoris, and tensor fasciae latae, does not dissect muscles around the hip and conserves the posterior tissue to a large extent, leading to improved stability and a reduced postoperative dislocation rate [6,8,[11][12][13]. As a consequence, reduction of the dislocation rate and early postoperative functional recovery can be expected [10].…”

Section: Introductionmentioning

confidence: 99%

“…When performing DAA, detachment of the joint capsule at appropriate sites is indispensable to obtain a clearer visual field during surgery [8,11]. However, despite careful capsular release and rasping, damage to muscles may occur [9], possibly eliminating one of the advantages of the approach.…”

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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“…In one cadaver study, the damage to the abductor muscles and the external rotators in THA using the direct anterior approach were reportedly limited compared with that in THA using the posterior approach [7]. Clinically, the dislocation rate is reportedly as low as that for a conventional direct lateral approach [4,5,8,12]. Early postoperative recovery is also apparently improved compared with that after THA using the miniposterior approach [9] and a conventional anterolateral approach [6].…”

Section: Introductionmentioning

confidence: 99%

“…Matsuura, H. Ohashi (&), Y. Okamoto, F. Inori, Y. Okajima Department of Orthopaedic Surgery, Saiseikai Nakatsu Hospital, 2-10-39, Shibata, Kita-ku, Osaka 530-0012, Japan e-mail: lu7h-oohs@asahi-net.or.jp to allow exposure of the acetabulum and femur through a single incision that does not require release of any muscles or tendons from the pelvis or femur [5,12]; we call this approach the ''direct anterior approach.'' When using the direct anterior approach in THA, view of and access to the acetabulum seem equal to those for any other surgical approaches [10], whereas a more demanding task is preparation of the femur [10].…”

Section: Introductionmentioning

confidence: 99%

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

Matsuura

Ohashi

Okamoto

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background The direct anterior approach in THA is an intermuscular approach that requires no muscle detachment. However, it is difficult to elevate the proximal femur for access to the femoral canal. Questions/purposes We asked (1) which part of the capsule should be released to allow effective elevation of the proximal femur; (2) whether the release of the internal obturator tendon allows elevation; and (3) whether hip hyperextension reduces the ability to elevate the femur. Methods We conducted a cadaver study and a clinical study. In the first study, the elevation of the proximal femur was measured in 6 hips in 3 cadavers after excision of the anterior capsule, after the release of the superior capsule or the posterior capsule, after the release of the superior and posterior capsule, and after the release of the internal obturator tendon under traction of 70 N. Each hip was positioned at 0°, 15°, and 25°hyperextension. In the second study of 39 patients, the posterior capsule was released after the superior capsule in the first 13 hips, and the superior capsule was released after the posterior capsule in the next 26 hips. The elevation achieved for each hip was measured as in the cadaver study.

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Single-incision Anterior Approach for Total Hip Arthroplasty on an Orthopaedic Table

Abstract: Therapeutic study, Level IV-1 (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Cited by 585 publications

References 23 publications

Total Hip Arthroplasty Surgical Approach Does Not Alter Postoperative Gait Mechanics One Year After Surgery

Total Hip Arthroplasty Surgical Approach Does Not Alter Postoperative Gait Mechanics One Year After Surgery

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

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

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