Hip Resurfacing and Anterior Approach

Abstract

In young and active patients, hip arthritis remains a challenge, whatever the improvements in materials, design, bone fixation and interfaces of total hip prosthesis (THR). Resurfacing provides a solution to at least some of these problems.

The anterior approach is the traditional approach for hip replacement in our department, as described and practised by Robert and Jean Judet since 1947, ­initially for the historical acrylic cephalic prosthesis and subsequently for all types of THR. It can be used as a truly minimally invasive approach as described by Siguier. This approach is now our standard approach for THR, allowing implantation without tendon or muscular section and taking advantage of the anteversion of both the neck and acetabulum.

This short prospective series involving just two types of implant does not allow any conclusion to be made about resurfacing concept: We have a favourable initial impression but as yet no answers regarding uncemented fixation, the prevention of bone trabecular modification, the incidence of metal ion release and so on.

On the other hand, the anterior approach performed on an efficient orthopaedic table seems to be recommendable. The only absolute contraindications are resurfacing combined with femoral osteotomy or cases where simultaneous metalwork removal is required.

So, for the marriage of resurfacing and a minimally invasive anterior approach, we have only great hopes for the implant but a complete and unrestricted faith in the approach!