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Note by Patricia Walter: Sometimes hip resurfacing surgeons are
not specific when they are talking about the "anterior approach to surgery"
since this can include the Direct Anterior Approach, the Anterolateral Approach
and other variations. The surgeons using the posterior approach often
refer to the "anterior approach" incorrectly to include all types of anterior approaches. Dr. Matta has written a comprehensive
explanation of the Anterior Approach to explain the misinformation often
presented.
The postings on your web site by some hip resurfacing surgeons is unfortunately
giving false information about the Posterior vs Anterior approach. They are
referring to the Anterior Approach in relation to what is now termed lateral
approach through which the abductor tendons (gluteus medius and gluteus minimus
muscles) are partially severed or detached from the femur. The approach they
erroneously refer to as anterior is also known as the Harding Approach. By
contradistinction the Anterior Approach follows the Smith-Petersen interval and
is an inter muscular and inter nervus approach. It detaches neither the hip
abductors nor the hip external rotators.
Surgeons also refer to repairing the hip capsule as a means to prevent
dislocation but more important resistance to hip dislocation comes from the
external rotator muscles, particularly the obturator externus muscle and these
tendons are severed with the Posterior Approach. The external rotator muscles
actively center the femoral head while the large gluteal muscles provide the
power. The external rotator muscles also power hip rotation which is important
for a number of sport activities including golf, tennis, skiing and martial
arts.
Anterior Approach Resurfacing is possible and I believe preferable over
posterior approach because of it's muscle sparing aspects. Also with the
Anterior Approach the patient is supine during surgery as opposed to lateral
with Posterior Approach. Supine position facilitates intra operative checks of
acetabular and femoral component position with x-ray which can improve accuracy.
Certainly whether Anterior or Posterior Approach is a better way to perform Hip
Resurfacing is a matter of medical opinion. Please understand however, that the
point I am making is that some hip resurfacing surgeons discussion does not
relate to Anterior Approach as presented at the 2008 Resurfacing Course or what
patients find when they "Google" Anterior Approach.
Sincerely,
Joel M. Matta, MD
Director, Hip and Pelvis Institute
St John’s Health Center, Santa Monica, Ca
www.hipandpelvis.com
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