Anterior-Based Muscle-Sparing (ABMS) Approach for Total Hip Arthroplasty.

The anterior-based muscle-sparing (ABMS) technique for total hip arthroplasty (THA) has gained popularity in recent years because of its proposed advantages in terms of postoperative pain and periprosthetic dislocation risk. Description: The procedure is performed with the patient in the supine position. A minimally invasive Watson-Jones approach is utilized to access the hip. Fluoroscopy can be utilized intraoperatively to assess acetabular cup position, version, and inclination. Femoral canal fill and leg lengths can also be assessed with use of fluoroscopy. Alternatives: Nonoperative alternatives for the treatment of hip osteoarthritis include nonsteroidal anti-inflammatory drugs, physical therapy, and corticosteroid injections into the hip joint. Surgical alternatives to this procedure include the posterior approach (Moore or Southern), the direct lateral approach (Hardinge), and the direct anterior approach (Smith-Petersen). The Watson-Jones approach can also be performed with the patient in the lateral decubitus position (unlike in our technique where the patient is supine). Rationale: The anterolateral (Watson-Jones) approach to the hip has been shown to be superior to the historically more common posterior approach with regard to length of hospital stay and dislocation risk Expected Outcomes: Compared with the historically common posterior approach to the hip for THA, the anterolateral approach to the hip leads to, on average, a lower risk of hip dislocation Important Tips: Although a pannus is more detrimental to a direct anterior approach, it could overlie the desired incision in the ABMS approach as well. The pannus could be held out of the field by taping it to the contralateral shoulder before preparing and draping.The preparative process is more time-consuming because both legs must be sterile for this procedure.Acetabular exposure often requires an assistant standing on the contralateral side of the table.Although not often needed, the obturator internus and gemelli might need to be released in order to ensure adequate exposure of the femur.If femoral canal exposure is still insufficient, a femoral suspension hook system might be needed. Acronyms & Abbreviations: ASIS = anterior superior iliac spineTFL = tensor fasciae lataeITB = iliotibial bandPOD = postoperative dayIV = intravenousBID = twice daily.