Skip to main content
SpringerLink
Log in

Acetabular Orientation: Anterolateral Approach in the Supine Position

  • Symposium: Papers Presented at the Hip Society Meetings 2008
  • Published:
Clinical Orthopaedics and Related Research

Abstract

The anterolateral approach in the supine position provides excellent visualization of the acetabulum. The main advantage of the approach, a low dislocation rate, has been demonstrated in the literature, while the purported disadvantage of abductor dysfunction has not been clearly delineated in the literature. The technique requires meticulous attention to preservation of the gluteus medius and minimus tendons. Impingement and dislocation are avoided by careful attention to the preparation of acetabulum, critical assessment of the implanted components, and intraoperative trialing. Leg lengths are assessed through direct palpation of the malleoli. Routine use of postoperative hip precautions is not necessary when this approach is utilized. The anterolateral approach in the supine position allows for a reproducible result with a low dislocation rate.

Level of Evidence: Level V, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Barber TC, Roger DJ, Goodman SB, Schurman DJ. Early outcome of total hip arthroplasty using the direct lateral vs. the posterior surgical approach. Orthopedics. 1996;19:873–875.

    CAS  Google Scholar 

  2. Barrack RL. Dislocation after total hip arthroplasty: implant design and orientation. J Am Acad Orthop Surg. 2003;11:89–99.

    PubMed  Google Scholar 

  3. Demos HA, Rorabeck CH, Bourne RB, MacDonald SJ, McCalden RW. Instability in primary total hip arthroplasty with the direct lateral approach. Clin Orthop Relat Res. 2001;393:168–180.

    Article  PubMed  Google Scholar 

  4. D’Lima DD, Urquhart AG, Buehler KO, Walker RH, Colwell Jr CW. The effect of the orientation of the acetabular and femoral components on the range of motion of the hip at different head-neck ratios. J Bone Joint Surg Am. 2000;82:315–321.

    PubMed  CAS  Google Scholar 

  5. Downing ND, Clark DI, Hutchinson JW, Coclough K, Howard PW. Hip abductor strength following total hip arthroplasty:a prospective comparison of the posterior and lateral approach in 100 patients. Acta Orthop Scand. 2001;72:215–220.

    Article  PubMed  CAS  Google Scholar 

  6. Frndak PA, Mallory TH, Lombardi Jr AV. Translateral surgical approach to the hip. The abductor muscle “split.” Clin Orthop Relat Res. 1993;295:135–141.

    PubMed  Google Scholar 

  7. Horwitz BR, Rockowitz NL, Goll SR, Booth Jr RE, Balderston RA, Rothman RH, Cohn JC. A prospective randomized comparison of two surgical approaches to total hip arthroplasty. Clin Orthop Relat Res. 1993;291:154–163.

    PubMed  Google Scholar 

  8. Jolles BM, Bogoch ER. Posterior versus lateral surgical approach for total hip arthroplasty in adults with osteoarthritis. Cochrane Database Syst Rev. 2006;19;3:CD003828.

    Google Scholar 

  9. Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hip replacement arthroplasties. J Bone Joint Surg Am. 1978;60:217–220.

    PubMed  CAS  Google Scholar 

  10. Madsen MS, Ritter MA, Morris HH, Meding JB, Berend ME, Faris PM, Vardaxis VG. The effect of total hip arthroplasty surgical approach on gait. J Orthop Res. 2004;22:44–50.

    Article  PubMed  Google Scholar 

  11. Mallory TH, Lombardi Jr AV, Fada RA, Herrington SM, Eberle RW. Dislocation after total hip arthroplasty using the anterolateral abductor split approach. Clin Orthop Relat Res. 1999;358:166–172.

    Article  PubMed  Google Scholar 

  12. Marumaya M, Feinberg JR, Capello WN, D’Antonio JA. The Frank Stinchfield award:Morphologic features of the acetabulum and femur:anteversion angle and implant positioning. Clin Orthop Relat Res. 2001;393:52–65.

    Article  Google Scholar 

  13. Masonis JL, Bourne RB. Surgical approach, abductor function, and total hip arthroplasty dislocation. Clin Orthop Relat Res. 2002;405:46–53.

    Article  PubMed  Google Scholar 

  14. Moskal JT, Mann III JW. A modified direct lateral approach for primary and revision total hip arthroplasty:a prospective analysis of 453 cases. J Arthroplasty. 1996;11:255–266.

    Article  PubMed  CAS  Google Scholar 

  15. Murray DW. The definition and measurement of acetabular orientation. J Bone Joint Surg Br. 1993;75:228–232.

    PubMed  CAS  Google Scholar 

  16. Nishii T, Sugano N, Miki H, Koyama T, Takao M, Yoshikawa H. Influence of component positions on dislocation. Computed tomographic evaluations in a consecutive series of total hip arthroplasty. J Arthroplasty. 2004;19:162–166.

    Article  PubMed  Google Scholar 

  17. Peak EL, Parvizi J, Ciminiello M, Purtill JJ, Sharkey PF, Hozack WJ, Rothman RH. The role of patient restrictions in reducing the prevalence of early dislocation following total hip arthroplasty. A randomized, prospective study. J Bone Joint Surg Am. 2005;87:247–253.

    Article  PubMed  Google Scholar 

  18. Ranawat CS, Maynard MJ. Modern techniques of cemented total hip arthroplasty. Tech Orthop. 1991;6:17–25.

    Article  Google Scholar 

  19. Ritter MA, Harty LD, Keating ME, Faris PM, Meding JB. A clinical comparison of the anterolateral and posterolateral approaches to the hip. Clin Orthop Relat Res. 2001;385:95–99.

    Article  PubMed  Google Scholar 

  20. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, Sage D, Futter M, Saville G, Clark T, MacMahon S. Reduction of post-operative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomized trials. BMJ. 2000;321:1493.

    Article  PubMed  CAS  Google Scholar 

  21. Usrey MM, Noble PC, Rudner LJ, Conditt MA, Birman MV, Santore RF, Mathis KB. Does neck/liner impingement increase wear of ultrahigh-molecular-weight polyethylene liners? J Arthroplasty. 2006;21:65–71.

    Article  PubMed  Google Scholar 

  22. Vicar AJ, Coleman CR. A comparison of the anterolateral, transtrochanteric, and posterior surgical approaches in primary total hip arthroplasty. Clin Orthop Relat Res. 1984;188:152–159.

    PubMed  Google Scholar 

  23. Walter WL, Insley GM, Walter WK, Tuke MA. Edge loading in third generation alumina ceramic-on-ceramic bearings. Stripe wear. J Arthroplasty. 2004;19:402–413.

    Article  Google Scholar 

  24. Walter WL, O’Toole GC, Walter WK, Ellis A, Zicat BA. Squeaking in ceramic-on-ceramic hips. The importance of acetabular component orientation. J Arthroplasty. 2007; 22:496–503.

    Google Scholar 

  25. Yamaguchi M, Akisue T, Bauer TW, Hasimoto Y. The spatial location of impingement in total hip arthroplasty. J Arthroplasty. 2000;15:305–313.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Rothman Institute, 925 Chestnut St., 5th Floor, Philadelphia, PA, 19107, USA

    Matthew S. Austin MD & Richard H. Rothman MD, PhD

Authors
  1. Matthew S. Austin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard H. Rothman MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Matthew S. Austin MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article; one of the authors (RHR) is a Consultant to Stryker Orthopaedics (Mahwah, NJ).

About this article

Cite this article

Austin, M.S., Rothman, R.H. Acetabular Orientation: Anterolateral Approach in the Supine Position. Clin Orthop Relat Res 467, 112–118 (2009). https://doi.org/10.1007/s11999-008-0523-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-008-0523-x

Keywords

Search

Navigation