Patrick F Bergin1, Anthony S Unger2. 1. Department of Orthopaedic Surgery and Rehabilitation, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216. E-mail address: pbergin@umc.edu. 2. Washington Orthopaedics and Sports Medicine, 2021 K Street, NW, Suite 400, Washington, DC 20006. E-mail address: ungeranthony@gmail.com.
Abstract
INTRODUCTION: In theory, the direct anterior approach offers the only path to performing minimally invasive total hip arthroplasty in an intermuscular, internervous plane. STEP 1 POSITION AND DRAPE PATIENT: Careful positioning is necessary to complete this procedure on a standard operating room table. STEP 2 SUPERFICIAL EXPOSURE: Incise the fascia overlying the tensor fasciae latae and lift up the anterior edge, avoiding the perforating vessels. STEP 3 DEEP EXPOSURE: The hip is flexed 30° during the deep dissection. STEP 4 PREPARE ACETABULUM AND IMPLANT ACETABULAR COMPONENT: Ream the acetabulum in 10° to 15° of anteversion with an abduction angle of 40° to 45°. STEP 5 PREPARE FEMUR AND IMPLANT FEMORAL COMPONENT: Use offset broaches to access the femur and prevent perforation through the greater trochanter. STEP 6 TRIAL AND CLOSE: Specifically check for impingement of bone on the implant with the hip flexed 90°. RESULTS: This approach has been used successfully for total hip arthroplasty for decades. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: In theory, the direct anterior approach offers the only path to performing minimally invasive total hip arthroplasty in an intermuscular, internervous plane. STEP 1 POSITION AND DRAPE PATIENT: Careful positioning is necessary to complete this procedure on a standard operating room table. STEP 2 SUPERFICIAL EXPOSURE: Incise the fascia overlying the tensor fasciae latae and lift up the anterior edge, avoiding the perforating vessels. STEP 3 DEEP EXPOSURE: The hip is flexed 30° during the deep dissection. STEP 4 PREPARE ACETABULUM AND IMPLANT ACETABULAR COMPONENT: Ream the acetabulum in 10° to 15° of anteversion with an abduction angle of 40° to 45°. STEP 5 PREPARE FEMUR AND IMPLANT FEMORAL COMPONENT: Use offset broaches to access the femur and prevent perforation through the greater trochanter. STEP 6 TRIAL AND CLOSE: Specifically check for impingement of bone on the implant with the hip flexed 90°. RESULTS: This approach has been used successfully for total hip arthroplasty for decades. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
Authors: Patrick F Bergin; Jason D Doppelt; Curtis J Kephart; Michael T Benke; James H Graeter; Andrew S Holmes; Hana Haleem-Smith; Rocky S Tuan; Anthony S Unger Journal: J Bone Joint Surg Am Date: 2011-08-03 Impact factor: 5.284
Authors: Eckart Mayr; Michael Nogler; Maria-Grazia Benedetti; Oliver Kessler; Andrea Reinthaler; Martin Krismer; Alberto Leardini Journal: Clin Biomech (Bristol, Avon) Date: 2009-08-21 Impact factor: 2.063