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The anterior-based muscle-sparing approach to the hip: the “other” anterior approach to the hip

  • Roberto Civinini
  • Andrea Cozzi Lepri
  • Christian Carulli
  • Fabrizio Matassi
  • Marco Villano
  • Massimo Innocenti
Original Paper
  • 99 Downloads

Abstract

Purpose

The purpose of this study was to evaluate safety, efficacy, and learning curves of anterior-based muscle-sparing total hip arthroplasty (ABMS-THA) in the supine position. Furthermore, early functional outcome was evaluated and compared to direct anterior approach (DAA) by measuring surface electromyography (sEMG).

Methods

We present a prospective cohort study of 343 hips. The safety and learning curve were assessed by recording operative time and peri-operative adverse events. For assessment of efficacy, functional and radiological outcomes were evaluated. A selected group of 32 patients have been studied by sEMG and compared to a matched group of 32 patients who received a THA using DAA approach.

Results

There was one dislocation (0.3%); two (0.6%) patients had an intra-operative fractures of the greater trochanter; two patients (0.6%) experienced a self-limited femoral nerve palsy. Physical therapy milestones for hospital discharge were reached on an average of 1.7 days. sEMG showed that ABMS and DAA have a similar muscle recruitment pattern and functional recovery after THA. One patient was revised for infection, 16 were lost, and 326 hips were available with a median follow-up of 42 months (range 24–60). The mean Harris Hip Score (HSS) increased from 44.3 to 91.9. Ninety-six percent of the hips had a leg length discrepancy (LLD) < 5 mm. There were no radiological signs of mechanical loosening or osteolysis.

Conclusions

The ABMS approach in the supine position is clinically effective and safe; special advantages include a very low dislocation rate and a great control of LLD.

Keywords

Total hip arthroplasty Anterior based muscle sparing approach Direct anterior approach 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Capuano N, Grillo G, Carbone F, Del Buono A (2018) Total hip arthroplasty performed with a tissue-preserving technique using superior capsulotomy. Int Orthop 42:281–287.  https://doi.org/10.1007/s00264-017-3722-9 CrossRefPubMedGoogle Scholar
  2. 2.
    Nistor DV, Caterev S, Bolboacă SD, Cosma D, Lucaciu DOG, Todor A (2017) Transitioning to the direct anterior approach in total hip arthroplasty. Is it a true muscle sparing approach when performed by a low volume hip replacement surgeon? Int Orthop 41:2245–2252.  https://doi.org/10.1007/s00264-017-3480-8 CrossRefPubMedGoogle Scholar
  3. 3.
    Leunig M, Faas M, von Knoch F, Naal FD (2013) Skin crease ‘bikini’ incision for anterior approach total hip arthroplasty: surgical technique and preliminary results. Clin Orthop Relat Res 471(7):2245–2252.  https://doi.org/10.1007/s11999-013-2806-0 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Lanting BA, Hartley KC, Raffoul AJ, Burkhart TA, Sommerville L, Martin GR, Howard JL, Johnson M (2017) Bikini versus traditional incision direct anterior approach: is there any difference in soft tissue damage? Hip Int 27(4):397–400.  https://doi.org/10.5301/hipint.5000478 CrossRefPubMedGoogle Scholar
  5. 5.
    Alecci V, Valente M, Crucil M, Minerva M, Pellegrino CM, Sabbadini DD (2011) Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: perioperative findings. J Orthop Traumatol 12(3):123–129.  https://doi.org/10.1007/s10195-011-0144-0 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Müller M, Tohtz S, Dewey M, Springer I, Perka C (2011) Age-related appearance of muscle trauma in primary total hip arthroplasty and the benefit of a minimally invasive approach for patients older than 70 years. Int Orthop 35:165–171.  https://doi.org/10.1007/s00264-010-1166-6 CrossRefPubMedGoogle Scholar
  7. 7.
    Radoicic D, Zec V, Elassuity WI, Azab MA (2018) Patient’s perspective on direct anterior versus posterior approach total hip arthroplasty. Int Orthop.  https://doi.org/10.1007/s00264-018-4002-z
  8. 8.
    von Rottkay E, Rackwitz L, Rudert M, Nöth U, Reichert JC (2018) Function and activity after minimally invasive total hip arthroplasty compared to a healthy population. Int Orthop 42:297–302.  https://doi.org/10.1007/s00264-017-3541-z CrossRefGoogle Scholar
  9. 9.
    Homma Y, Baba T, Kobayashi H, Desroches A, Ozaki Y, Ochi H, Matsumoto M, Yuasa T, Kaneko K (2016) Safety in early experience with a direct anterior approach using fluoroscopic guidance with manual leg control for primary total hip arthroplasty: a consecutive one hundred and twenty case series. Int Orthop 40:2487–2494.  https://doi.org/10.1007/s00264-016-3159-6 CrossRefPubMedGoogle Scholar
  10. 10.
    Post ZD, Orozco F, Diaz-Ledezma C, Hozack WJ, Ong A (2014) Direct anterior approach for total hip arthroplasty: indications, technique, and results. J Am Acad Orthop Surg 22(9):595–603.  https://doi.org/10.5435/JAAOS-22-09-595 CrossRefPubMedGoogle Scholar
  11. 11.
    Kelley SS, Seyler TM, Hallows RK (2015) Total hip replacement: anterior-based, muscle-sparing approach without use of a fracture table. In: Lieberman J, Berry D (eds) AAOS Advanced Reconstruction Hip 2, Rosemont, pp 186–193Google Scholar
  12. 12.
    Watson-Jones R (1936) Fractures of the neck of the femur. Br J Surg 23:787–808CrossRefGoogle Scholar
  13. 13.
    Yu S, Garvin KL, Healy WL, Pellegrini VD Jr, Iorio R (2015) Preventing hospital readmissions and limiting the complications associated with total joint arthroplasty. J Am Acad Orthop Surg 23:e60–e71.  https://doi.org/10.5435/JAAOS-D-15-00044 CrossRefPubMedGoogle Scholar
  14. 14.
    Woo RY, Morrey BF (1982) Dislocations after total hip arthroplasty. J Bone Joint Surg Am 64(9):1295–1306CrossRefGoogle Scholar
  15. 15.
    Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr (1973) Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am 55(8):1629–1632CrossRefGoogle Scholar
  16. 16.
    Cram JR, Kasman GS, Holtz J (1998) Electrode placements. In: Gaithersburg (ed) Introduction to surface electromyography. Aspen Publishers, New York, p 237Google Scholar
  17. 17.
    Bolgla L, Uhl T (2005) Electromyographic analysis of hip rehabilitation exercises in a group of healthy subjects. J Orthop Sports Phys Ther 35:487–494.  https://doi.org/10.2519/jospt.2005.35.8.487 CrossRefPubMedGoogle Scholar
  18. 18.
    Basmajian J, De Luca C (1985) Muscles alive. Their functions revealed by electromyography. Williams and Wilkins, BaltimoreGoogle Scholar
  19. 19.
    Kendall F, McCreary E, Provance P (1993) Muscles. Testing and function. Williams & Wilkins, BaltimoreGoogle Scholar
  20. 20.
    Bertin KC, Röttinger H (2004) Anterolateral mini-incision hip replacement surgery: a modified Watson-Jones approach. Clin Orthop Relat Res 429:248–255CrossRefGoogle Scholar
  21. 21.
    Hansen BJ, Hallows RK, Kelley SS (2011) The Rottinger approach for total hip arthroplasty: technique and review of the literature. Curr Rev Musculoskelet Med 4(3):132–138.  https://doi.org/10.1007/s12178-011-9093-8 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Delanois RE, Sultan AA, Albayar AA, Khlopas A, Gwam CU, Sodhi N, Lamaj S, Newman JM, Mont MA (2017) The Röttinger approach for total hip arthroplasty: technique, comparison to the direct lateral approach and review of literature. Ann Transl Med 5(Suppl 3):S31.  https://doi.org/10.21037/atm.2017.11.21 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    de Jong L, Klem TMAL, Kuijper TM, Roukema GR (2018) The minimally invasive anterolateral approach versus the traditional anterolateral approach (Watson-Jones) for hip hemiarthroplasty after a femoral neck fracture: an analysis of clinical outcomes. Int Orthop 42:1943–1948.  https://doi.org/10.1007/s00264-017-3756-z CrossRefPubMedGoogle Scholar
  24. 24.
    Inaba Y, Kobayashi N, Yukizawa Y, Ishida T, Iwamoto N, Saito T (2011) Little clinical advantage of modified Watson-Jones approach over modified mini-incision direct lateral approach in primary total hip arthroplasty. J Arthroplast 26(7):1117–1122.  https://doi.org/10.1016/j.arth.2011.04.002 CrossRefGoogle Scholar
  25. 25.
    Müller M, Tohtz S, Dewey M, Springer I, Perka C (2010) Evidence of reduced muscle trauma through a minimally invasive anterolateral approach by means of MRI. Clin Orthop Relat Res 468(12):3192–3200.  https://doi.org/10.1007/s11999-010-1378-5 CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Muller M, Tohtz S, Springer I, Dewey M, Perka C (2011) Randomized controlled trial of abductor muscle damage in relation to the surgical approach for primary total hip replacement: minimally invasive anterolateral versus modified direct lateral approach. Arch Orthop Trauma Surg 131:179–189.  https://doi.org/10.1007/s00402-010-1117-0 CrossRefPubMedGoogle Scholar
  27. 27.
    Kawarai Y, Iida S, Nakamura J, Shinada Y, Suzuki C, Ohtori S (2017) Does the surgical approach influence the implant alignment in total hip arthroplasty? Comparative study between the direct anterior and the anterolateral approaches in the supine position. Int Orthop 41:2487–2493.  https://doi.org/10.1007/s00264-017-3521-3 CrossRefPubMedGoogle Scholar
  28. 28.
    Batailler C, Fary C, Batailler P, Servien E, Neyret P, Lustig S (2017) Total hip arthroplasty using direct anterior approach and dual mobility cup: safe and efficient strategy against post-operative dislocation. Int Orthop 41:499–506.  https://doi.org/10.1007/s00264-016-3333-x CrossRefPubMedGoogle Scholar
  29. 29.
    D'Arrigo C, Speranza A, Monaco E, Carcangiu A, Ferretti A (2009) Learning curve in tissue sparing total hip replacement: comparison between different approaches. J Orthop Traumatol 10(1):47–54.  https://doi.org/10.1007/s10195-008-0043-1 CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Falez F, Papalia M, Favetti F, Panegrossi G, Casella F, Mazzotta G (2017) Total hip arthroplasty instability in Italy. Int Orthop 41:635–644.  https://doi.org/10.1007/s00264-016-3345-6 CrossRefPubMedGoogle Scholar
  31. 31.
    Unis DB, Hawkins EJ, Alapatt MF, Benitez CL (2013) Postoperative changes in the tensor fasciae latae muscle after using the modified anterolateral approach for total hip arthroplasty. J Arthroplast 28:663–665.  https://doi.org/10.1016/j.arth.2012.06.032 CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Orthopaedic Clinic, Department of Surgery and Translational MedicineUniversity of FlorenceFlorenceItaly

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