Anterior Approach for Total Hip Arthroplasty: Technique Without Fracture Table

Abstract

Objective. To describe the minimally invasive anterior approach for total hip arthroplasty using a standard operating room table and report the short-term outcomes in a series of 128 patients. Indications. So-called primary osteoarthritis, rheumatoid arthritis, and degenerative arthritis of the hip. Contraindications. Complex primary hips might be avoided, such as hips after prior hip surgery, revision total hip arthroplasty, posterior acetabular deficiency, proximal femoral deformities, or difficult dysplastic cases as a Crowe type 4 deformity. Surgical Technique. Through a straight 8–10 cm incision starting 2 cm lateral and distal to the ASIS the fascia of the TFL is opened anteriorly. After obtaining hemostasis, the rectus femoris is identified and retracted medially with or without transecting the indirect head. The gluteus medius and minimus and TFL are retracted laterally to expose the hip capsule. After capsulectomy and femoral neck osteotomy, the acetabulum is exposed. The patients’ legs are placed in the figure-of-four position, with the operative hip extended and the femur externally rotated to expose the femoral canal. A press fit or cemented femoral component can be used with this approach. Postoperative Management. Postoperatively, hip flexion is limited to 90° for 4 weeks. Patients are encouraged to ambulate on postoperative day 1 and are usually ready for discharge to home by postoperative day 4. Results. One hundred and 141 hips were operated on in 128 patients during a 1-year period (2007). There were 26 cemented femoral stems implanted, and 115 were press fit. All acetabular components were press fit. The mean patient age was 68 years, of which 84 were females and 57 were males. The average operative time ranged from 60 to 75 min. There were three complications: one dislocation (0.7 %) which did not require treatment and two revisions (1.4 %) for a socket fracture after a low velocity trauma and a cup revision for persistent iliopsoas pain. Radiographic evaluation of acetabular cup position demonstrated the median abduction angle of 44° and anteversion of 23°.