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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

The direct anterior approach recently has increased in popularity, arguably in response to device companies’ direct-to-consumer marketing efforts for 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 described an anterior-based muscle-sparing approach without detachment of the abductor muscles. Although similar to the direct anterior approach, the anterior-based muscle-sparing approach involves the use of a standard surgical table; is an extensile approach; is not associated with weight/body mass index limitations; involves the use of an inexpensive surgical table; may be performed with the use of fluoroscopy; can be performed with the patient in the supine or lateral decubitus position; allows for range of motion testing; and allows for the use of any implant design, including reamed and cemented implants. The anterior-based muscle-sparing approach is associated with a few contraindications. Similar to any muscle-sparing approach for total hip arthroplasty, there is enthusiasm and concern. The approach is technically demanding. Access to the posterior acetabular wall for hardware removal and posterior wall bone grafting should be considered relative contraindications to the approach. The anterior-based muscle-sparing approach is associated with a learning curve, and the authors of this video recommend practicing the approach on cadaver models and surgeon visitation prior to clinical implementation.

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