Enhanced Early Outcomes with the Anterior Supine Intermuscular Approach in Primary Total Hip Arthroplasty
Keith R. Berend, MD; Adolph V. Lombardi Jr., MD; Brian E. Seng, DO; Joanne B. Adams, BFA


The advantages of minimally invasive surgical approaches for total hip arthroplasty are reported to include reduced blood loss, less pain, and shorter hospital stays, which combine to afford a faster recovery1-4. However, other studies have failed to show any significant advantage over the use of standard surgical approaches (Fig. 1)5-8. Reported disadvantages of minimally invasive techniques are the substantial learning curve required and an increased risk of early complications3,9-12. In addition, the long-term outcomes of minimally invasive procedures in terms of implant fixation and longevity remain unproven.

Fig. 1

The standard direct lateral approach to the hip previously described by Frndak et al.21 is performed with the patient in the lateral decubitus position. (Printed with permission of Joint Implant Surgeons, Inc.)

There are three basic categories of so-called minimally invasive total hip arthroplasty approaches: an abbreviated incision (small incision), modifications of standard approaches with smaller incisions and less soft-tissue dissection (less invasive), and novel approaches that reportedly do not cut muscle (minimally invasive). We have had a broad experience, over the past seven years, with a less invasive modification of the direct lateral approach (a modified Hardinge approach) (Fig. 2). We previously reported less blood loss and a shorter hospital stay in association with this approach13. Others have argued that the less invasive direct lateral approach does not provide an advantage over the traditional approach5. Importantly, the soft-tissue dissection still requires removing and repairing the abductor musculature.

Fig. 2

The less invasive direct lateral approach is performed with the patient in the lateral decubitus position. This approach employs an abbreviated skin and fascial incision with a limited abductor muscle dissection13. (Printed with permission of Joint Implant Surgeons, Inc.)

Several recent reports have …

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