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Primary Total Hip Arthroplasty: ABMS (Anterior-based Muscle-sparing Approach)

March 01, 2017

Contributors: Rhett Hallows, MD; Scott S Kelley, MD; James Messersmith, PA-C; Thorsten M Seyler, MD, PhD; Johannes F Plate, MD, PhD; Johannes F Plate, MD, PhD

In recent years, the direct anterior approach has gained in popularity, arguably in response to device companies’ direct-to-consumer marketing efforts of new implant designs and subsequent patient demands. Watson-Jones described a surgical interval to expose femoral neck fractures but never described a surgical approach to the hip joint. Based on the classic Watson-Jones muscle interval, Bertin and Rottinger initially described an anterior-based muscle-sparing approach (ABMS) without detachment of the abductor muscles. While it is similar in many respects to the direct anterior approach, it utilizes a standard operating room table and has the following advantages over the direct anterior approach: it is extensile, there are no weight/BMI limitations, inexpensive operating room table, fluoroscopy is optional, it can be performed in the supine or lateral decubitus position, the surgeon has the ability to perform range of motion testing, and most importantly, it allows the surgeon to use any implant design, including reamed-based and cemented implants. There are few contraindications known for the ABMS approach. As with any muscle sparing approach to total hip arthroplasty, there is both enthusiasm and concern. This is a technically demanding approach and access to the posterior acetabular wall for hardware removal and posterior wall bone grafting should be considered relative contraindications for using this approach. The ABMS approach is associated with a learning curve and the authors recommend practicing the approach on cadaveric specimen and surgeon visitation prior to clinical implementation.

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