The Röttinger approach for total hip arthroplasty: technique, comparison to the direct lateral approach and review of literature.

backgroundMultiple approaches to the hip joint have been developed utilizing various intervals and/or intermuscular planes when performing a total hip arthroplasty (THA), each proposing certain advantages. Of these, the Röttinger approach (modified anterolateral or Watson-Jones) is potentially muscle-sparing. Multiple studies have demonstrated favorable outcomes with this approach. However, others showed more complications with a slow learning curve. Due to the paucity of evidence we conducted this study to: (I) present our operative experience and technique of the Röttinger approach; (II) compare short-term complications and operative room (OR) times of this approach to the direct lateral; and (III) review the available literature.

methodsThis was a review of a longitudinally maintained single-surgeon database of patients who underwent primary THA using either the Röttinger or direct lateral approach. A total of 100 consecutive patients (100 hips) who underwent primary unilateral THA using the Röttinger approach between April 1

resultsAt mean follow-up time of 12 weeks (range, 6 to 24 weeks), there were two patients in the Röttinger cohort who experienced lateral femoral cutaneous nerve palsies (2%), which were self-limited and resolved at 6 and 12 weeks. In the direct lateral cohort, there was one hip dislocation (2%) at 6 weeks post-operatively, which was successfully managed by a closed reduction. In patients who received the Röttinger approach, mean OR time was 130 minutes (range, 74 to 202 minutes), compared to the direct lateral cohort mean of 111 minutes (range, 71 to 222 minutes). Our literature analysis covered 2,252 patients who received the Röttinger approach

conclusionsIn this analysis of a single-surgeon experience of the Röttinger approach compared to the direct lateral, we presented our experience with the technique and demonstrated the safety and feasibility of this relatively novel approach. Our study results demonstrated that patients who underwent this approach had similar short-term complications and OR times to those who underwent the direct lateral approach. Additionally, our findings agree with previous comparative studies that demonstrated similar outcomes of this approach. Therefore, it can be used as an alternative for primary THA.