Anatomy of the Hip Joint.- Complications.- Patient Selection, Indications and Contraindications.- The Anterior Approach.- The Anterolateral Approach with the Patient in Lateral Position.- The Anterolateral Approach with the Patient in Supine Position.- The Posterior Approach.- Epilogue.
"5 The Anterior Approach (p. 27-28)
Etienne Lesur
5.1 Introduction
Minimally invasive total hip arthroplasty (THA) by the anterior approach is based on a resection-reconstruction technique that was pioneered by Robert Judet in 1947 [1–3]. Judet developed the technique in post-war France, at a time when surgeons were faced with an increased number of patients presenting with femoral neck fractures.
He was able to use the experience gained from these pelvic operations in order to improve on the conventional anterior approach for hip arthroplasty, which until then had relied on larger incisions [4]. We agree with Judet in recognizing that the anterior approach had a number of important surgical advantages [1, 5]. This approach allowed for the closest access to the hip, followed by an inter-nervous plane, and maintained the muscles undisturbed.
By applying the Hueter incision procedure to the anterior approach, Judet was able to achieve excellent outcomes with regard to post-operative recovery of function and reduced levels of pain [1]. For the anterior approach, we advocate using an orthopaedic fracture table that was originally designed by Judet [1, 5].
The MIS anterior approach has been used by Lesur and co-workers since 1993 [6], and their findings are described in this chapter. Lesur [6] has based his approach on the original technique of Judet [1], and later modifications by Letournel [7]. Over time, he simplified this technique, which allows peri-operative complications to be minimised.
By taking advantage of modern developments in prosthesis design, material composition and specially designed surgical instrumentation used for implanting, Lesur (a fellow of Letournel) has succeeded in improving upon the original technique of Hueter. Lesur [6] identified structural landmarks that act as a road map into the hip. This makes the MIS anterior approach relatively easy for any surgeon who is reasonably well skilled in dissection and minimal invasive surgery. Currently, patients undergoing THA by the MIS anterior approach of Lesur [6] may expect to walk on the same day only hours after the operation, have a shorter hospital stay, and have less post-operative pain. This facilitates their rapid rehabilitation and return to daily activities."
