Anterolateral Mini-incision Total Hip Arthroplasty

Abstract

At the advent of the total hip arthroplasty (THA), Charnley advocated the transtrochanteric approach (“the lateral exposure with elevation of the greater trochanter”) for THAs.¹ However, surgeons such as Müller and Harris argued that there were many advantages to performing primary THAs without a trochanteric osteotomy, including a shortened operative time, less blood loss, elimination of the need to perform a trochanteric repair, avoidance of common trochanteric complications (e.g., nonunion and painful bursitis due to the irritation caused by the metal fixation wires), and earlier return to unsupported weight bearing.²,³ The most popular alternatives to the transtrochanteric approach are the posterior or posterolateral, the direct lateral, and the anterolateral approaches.

In his 1935 description of femoral neck fracture treatment, Watson-Jones described the anterolateral approach entailing an exposure of the femoral neck through the interval between the gluteus medius and the tensor fasciae femoris. To provide better exposure, he describes dissecting the anterior fibers of the gluteus medius insertion off of the trochanter. In cases where still further exposure is needed, he advocated driving an osteotome into the front of the trochanter and levering out on its intact posterior margin. He warns surgeons not to fully separate the trochanter to avoid bleeding.⁴