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Minimally Invasive Direct Lateral Approach

  • David A. CrawfordEmail author
  • Adolph V. LombardiJr.
Reference work entry

Abstract

The development of minimally invasive techniques along with implementation of rapid recovery pathways has improved patient recovery from total hip arthroplasty (THA). The traditional direct lateral approach afforded great access for THA with low dislocation rates, but came at the cost of prolonged recovery of the abductor mechanism. Over the years, the direct lateral approach has been modified to minimize release of the abductors and lessen soft tissue dissection, which has been aided by the development of MIS instrumentation. The MIS direct lateral approach allows familiar patient positioning, does not require special OR tables, and can be used for both primary THA and revision surgery. With this approach, exposure to both the femur and acetabulum is easily accomplished. Patients will have a more rapid recovery with shorter hospital length of stay, and dislocation rate remains low. In this chapter, we describe the surgical technique for MIS direct lateral total hip arthroplasty and discuss the literature supporting its use.

Keywords

Primary total hip arthroplasty Direct lateral approach Anterolateral approach Minimally invasive surgery Less invasive Patient positioning Abductor mechanism Rapid recovery Length of stay Exposure Dislocation Rehabilitation 

References

  1. 1.
    Lombardi Jr AV, Berend KR, Mallory TH. Perioperative management – rapid recovery protocol. In: Breusch SJ, Malchau H, editors. The well cemented total hip arthroplasty – theory and practice. Heidelberg: Springer; 2005. p. 307–12.CrossRefGoogle Scholar
  2. 2.
    Berend KR, Lombardi Jr AV, Mallory TH. Rapid recovery protocol for peri-operative care of total hip and total knee arthroplasty patients. Surg Technol Int. 2004;13:239–47.PubMedGoogle Scholar
  3. 3.
    Mallory TH, Lombardi Jr AV, Fada RA, Dodds KL, Adams JB. Pain management for joint arthroplasty: preemptive analgesia. J Arthroplasty. 2002;17 Suppl 1:129–33.CrossRefPubMedGoogle Scholar
  4. 4.
    Mallory TH, Lombardi Jr AV, Fada RA, Dodds KL. Anesthesia options: choices and caveats. Orthopedics. 2000;23(9):919–20.PubMedGoogle Scholar
  5. 5.
    Sheth D, Cafri G, Inacio MC, Paxton EW, Namba RS. Anterior and anterolateral approaches for THA are associated with lower dislocation risk without higher revision risk. Clin Orthop Relat Res. 12 Mar 2015. [Epub ahead of print].Google Scholar
  6. 6.
    Masonis JL, Bourne RB. Surgical approach, abductor function, and total hip arthroplasty dislocation. Clin Orthop Relat Res. 2002;405:46–53.CrossRefPubMedGoogle Scholar
  7. 7.
    Restrepo C, Parvizi J, Pour AE, Hozack WJ. Prospective randomized study of two surgical approaches for total hip arthroplasty. J Arthroplasty. 2010;25(5):671–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Alecci V, Valente M, Crucil M, Minerva M, Pellegrino CM, Sabbadini DD. Comparison of primary total hip replacements performed with a direct anterior approach versus the standard lateral approach: perioperative findings. J Orthop Traumatol. 2011;12(3):123–9.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Queen RM, Butler RJ, Watters TS, Kelley SS, Attarian DE, Bolognesi MP. The effect of total hip arthroplasty surgical approach on postoperative gait mechanics. J Arthroplasty. 2011;26:66–71.CrossRefPubMedGoogle Scholar
  10. 10.
    Hardinge K. The direct lateral approach to the hip. J Bone Joint Surg Br. 1982;64-B(1):17–9.Google Scholar
  11. 11.
    Frndak PA, Mallory TH, Lombardi Jr AV. Translateral surgical approach to the hip: the abductor muscle “split”. Clin Orthop Relat Res. 1993;295:135–41.PubMedGoogle Scholar
  12. 12.
    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;358:166–72.CrossRefPubMedGoogle Scholar
  13. 13.
    de Beer J, Petruccelli D, Zalzal P, Winemaker MJ. Single- incision, minimally invasive total hip arthroplasty: length doesn’t matter. J Arthroplasty. 2004;19(8):945–50.CrossRefPubMedGoogle Scholar
  14. 14.
    Smith TM, Berend KR, Lombardi Jr AV, Mallory TH, Russell JH. Isolated liner exchange using the anterolateral approach is associated with a low risk of dislocation. Clin Orthop Relat Res. 2005;441:221–6.CrossRefPubMedGoogle Scholar
  15. 15.
    O’Brien JJ, Burnett RS, McCalden RW, MacDonald SJ, Bourne RB, Rorabeck CH. Isolated liner exchange in revision total hip arthroplasty: clinical results using the direct lateral surgical approach. J Arthroplasty. 2004;19(4):414–23.CrossRefPubMedGoogle Scholar
  16. 16.
    Wade FA, Rapuri VR, Parvizi J, Hozack WJ. Isolated acetabular polyethylene exchange through the anterolateral approach. J Arthroplasty. 2004;19(4):498–500.CrossRefPubMedGoogle Scholar
  17. 17.
    Berend KR, Lombardi Jr AV. Total hip arthroplasty via the less invasive anterolateral abductor splitting approach. Semin Arthroplasty. 2004;15:87–93.CrossRefGoogle Scholar
  18. 18.
    Bernasek TL, Lee WS, Lee HJ, Lee JS, Kim KH, Yang JJ. Minimally invasive primary THA: anterolateral intermuscular approach versus lateral transmuscular approach. Arch Orthop Trauma Surg. 2010;130(11):1349–54.CrossRefPubMedGoogle Scholar
  19. 19.
    Inaba Y, Kobayashi N, Yukizawa Y, Ishida T, Iwamoto N, Saito T. Little clinical advantage of modified Watson-Jones approach over modified mini-incision direct lateral approach in primary total hip arthroplasty. J Arthroplasty. 2011;26:1117–22.CrossRefPubMedGoogle Scholar
  20. 20.
    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;393:168–80.CrossRefPubMedGoogle Scholar
  21. 21.
    Howell JR, Masri BA, Duncan CP. Minimally invasive versus standard incision anterolateral hip replacement: a comparative study. Orthop Clin North Am. 2004;35(2):153–62.CrossRefPubMedGoogle Scholar
  22. 22.
    Berger RA. Mini-incision total hip replacement using an anterolateral approach: technique and results. Orthop Clin North Am. 2004;35(2):143–51.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland (outside the USA) 2016

Authors and Affiliations

  1. 1.Joint Implant Surgeons, Inc.New AlbanyUSA

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