Anterolateral Mini-incision Total Hip Arthroplasty

  • Sanaz Hariri
  • Andrew A. Freiberg


At the advent of the total hip arthroplasty (THA), Charnley advocated the transtrochanteric approach (“the lateral exposure with elevation of the greater trochanter”) for THAs.1 However, surgeons such as Müller and Harris argued that there were many advantages to performing primary THAs without a trochanteric osteotomy, including a shortened operative time, less blood loss, elimination of the need to perform a trochanteric repair, avoidance of common trochanteric complications (e.g., nonunion and painful bursitis due to the irritation caused by the metal fixation wires), and earlier return to unsupported weight bearing.2,3 The most popular alternatives to the transtrochanteric approach are the posterior or posterolateral, the direct lateral, and the anterolateral approaches.

In his 1935 description of femoral neck fracture treatment, Watson-Jones described the anterolateral approach entailing an exposure of the femoral neck through the interval between the gluteus medius and the tensor fasciae femoris. To provide better exposure, he describes dissecting the anterior fibers of the gluteus medius insertion off of the trochanter. In cases where still further exposure is needed, he advocated driving an osteotome into the front of the trochanter and levering out on its intact posterior margin. He warns surgeons not to fully separate the trochanter to avoid bleeding.4


Great Trochanter Gluteus Medius Anterolateral Approach Primary THAs Trochanteric Osteotomy 
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  1. 1.
    Charnley J. Total hip replacement by low-friction arthroplasty. Clin Orthop Relat Res. 1970;72:7–21PubMedGoogle Scholar
  2. 2.
    Harris WH. A new approach to total hip replacement without osteotomy of the greater trochanter. Clin Orthop Relat Res. 1975(106): 19–26CrossRefPubMedGoogle Scholar
  3. 3.
    Muller ME. Total hip prostheses. Clin Orthop Relat Res. 1970;72: 46–68PubMedGoogle Scholar
  4. 4.
    Watson-Jones R. Fractures of the neck of the femur. Br J Surg. 1935–36;23:787–808CrossRefGoogle Scholar
  5. 5.
    McKee GK, Watson-Farrar J. Replacement of arthritic hips by the McKee-farrar prosthesis. J Bone Joint Surg Br. 1966;48:245–259PubMedGoogle Scholar
  6. 6.
    Dall D. Exposure of the hip by anterior osteotomy of the greater trochanter. A modified anterolateral approach. J Bone Joint Surg Br. 1986;68:382–386PubMedGoogle Scholar
  7. 7.
    Hardinge K. The direct lateral approach to the hip. J Bone Joint Surg Br. 1982;64:17–19PubMedGoogle Scholar
  8. 8.
    Mallory TH. Total hip replacement with and without trochanteric osteotomy. Clin Orthop Relat Res. 1974:133–135Google Scholar
  9. 9.
    Thompson RC, Jr, Culver JE. The role of trochanteric osteotomy in total hip replacement. Clin Orthop Relat Res. 1975(106):102–106CrossRefPubMedGoogle Scholar
  10. 10.
    Vicar AJ, Coleman CR. A comparison of the anterolateral, transtrochanteric, and posterior surgical approaches in primary total hip arthroplasty. Clin Orthop Relat Res. 1984(188):152–159PubMedGoogle Scholar
  11. 11.
    Ritter MA, Harty LD, Keating ME, Faris PM, Meding JB. A clinical comparison of the anterolateral and posterolateral approaches to the hip. Clin Orthop Relat Res. 2001(385):95–99CrossRefPubMedGoogle Scholar
  12. 12.
    Kwon MS, Kuskowski M, Mulhall KJ, Macaulay W, Brown TE, Saleh KJ. Does surgical approach affect total hip arthroplasty dislocation rates? Clin Orthop Relat Res. 2006;447:34–38CrossRefPubMedGoogle Scholar
  13. 13.
    Jacobs LG, Buxton RA. The course of the superior gluteal nerve in the lateral approach to the hip [see comment]. J Bone Joint Surg Am. 1989;71(8):1239–1243PubMedGoogle Scholar
  14. 14.
    Higuchi F, Gotoh M, Yamaguchi N, et al. Minimally invasive uncemented total hip arthroplasty through an anterolateral approach with a shorter skin incision. J Orthop Sci. 2003;8(6):812–817CrossRefPubMedGoogle Scholar
  15. 15.
    Berger RA. Mini-incision total hip replacement using an anterolateral approach: technique and results. Orthop Clin North Am. 2004;35: z143–151CrossRefPubMedGoogle Scholar
  16. 16.
    Jerosch J, Theising C, Fadel ME. Antero-lateral minimal invasive (ALMI) approach for total hip arthroplasty technique and early results. Arch Orthop Trauma Surg. 2006;126:164–173CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of OrthopedicsMassachusetts General Hospital, Yawkey Center for Outpatient CareBostonUSA

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