Total Hip Arthroplasty Through a Minimally Invasive Anterior Surgical Approach

Kennon, Robert; Keggi, John M.; Wetmore, Robert S.; Zatorski, Laurine E.; Huo, Michael H.; Keggi, Kristaps J.

doi:10.2106/00004623-200300004-00005

Cited by 394 publications

(230 citation statements)

References 9 publications

Supporting

Mentioning

201

Contrasting

Unclassified

Order By: Relevance

“…Minimally invasive THA (MIS-THA) that minimizes soft tissue dissection reportedly reduces blood loss [3], does not increase complication rates [3,6,13], and improves early walking ability compared with conventional THA [3,4]. 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].…”

Section: Introductionmentioning

confidence: 99%

“…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%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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.

show abstract

Section: Introductionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…The surgical technique of direct anterior approach for THA has been described by a number of authors [3,5,[10][11][12]. The exposure of the acetabulum that is obtained with this approach is reportedly equal to that obtained with any other surgical approach [10], whereas effort is required to expose the proximal femur and elevate it almost to the skin level to allow for more or less straight access to the femoral canal [10].…”

Section: Discussionmentioning

confidence: 99%

“…Elevation of the proximal femur is then aided by a bone hook or retractors, and then the capsule and external rotators are released. Capsular releases have been variably described, and the strategy for releasing external rotators is not systematic [3,5,[10][11][12]. Some authors specify the superior portion of the capsule as the first part to be released; others specify instead the superior portion, the lateral portion, or the posterior portion.…”

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

View full text Add to dashboard Cite

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.

show abstract

“…Some investigators report MIS techniques result in faster rehabilitation and rapid recovery after THA [4,7,8,11,17,18,26,28]. Currently, conclusive evidence is lacking to support that a certain surgical approach provides a faster recovery and return to function.…”

Section: Discussionmentioning

confidence: 99%

Early Discharge and Recovery with Three Minimally Invasive Total Hip Arthroplasty Approaches: A Preliminary Study

Meneghini

Smits

2009

Clin Orthop Relat Res

View full text Add to dashboard Cite

Purported advantages of THA performed with minimally invasive surgical approaches include less muscle damage and faster recovery. The purpose of this preliminary investigation was to determine if differences existed between minimally invasive approaches in hospital discharge and early functional recovery in THA patients with a rapid rehabilitation protocol. Twenty-four consecutive patients were randomized to one of three minimally invasive surgical approaches (two-incision, mini-posterior, and mini-

show abstract

Total Hip Arthroplasty Through a Minimally Invasive Anterior Surgical Approach

Cited by 394 publications

References 9 publications

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

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

Early Discharge and Recovery with Three Minimally Invasive Total Hip Arthroplasty Approaches: A Preliminary Study

Contact Info

Product

Resources

About