The Wuerzburg procedure: the tensor fasciae latae perforator is a reliable anatomical landmark to clearly identify the Hueter interval when using the minimally-invasive direct anterior approach to the hip joint

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Abstract

Background

The key for successful delivery in minimally-invasive hip replacement lies in the exact knowledge about the surgical anatomy. The minimally-invasive direct anterior approach to the hip joint makes it necessary to clearly identify the tensor fasciae latae muscle in order to enter the Hueter interval without damaging the lateral femoral cutaneous nerve. However, due to the inherently restricted overview in minimally-invasive surgery, this can be difficult even for experienced surgeons.

Methods and Surgical Technique

In this technical note, we demonstrate for the first time how to use the tensor fasciae latae perforator as anatomical landmark to reliably identify the tensor fasciae latae muscle in orthopaedic surgery. Such perforators are used for flaps in plastic surgery as they are constant and can be found at the lateral third of the tensor fasciae latae muscle in a direct line from the anterior superior iliac spine.

Conclusion

As demonstrated in this article, a simple knowledge transfer between surgical disciplines can minimize the complication rate associated with minimally-invasive hip replacement.

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Most cited references 22

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Single-incision anterior approach for total hip arthroplasty on an orthopaedic table.

Joel M Matta, Cambize Shahrdar, T. Ferguson (2005)

Dislocation remains the leading early complication of total hip arthroplasty; surgical approach and implant positioning have been recognized as factors influencing total hip arthroplasty stability. We describe a total hip arthroplasty technique done through a single, tissue sparing anterior approach that allows implantation of the femoral and acetabular components without detaching or sectioning any of the muscles and tendons around the hip joint. A series of 437 consecutive, unselected patients who had 494 primary total hip arthroplasty surgeries done through an anterior approach on an orthopaedic table from September 1996 to September 2004 was reviewed. There were 54 hybrid and 442 uncemented hips in the 437 patients (57 bilateral). The average patient age was 64 years. Radiographic analysis showed an average abduction angle of 42 degrees , with 96% in the range of 35 degrees to 50 degrees abduction. The average cup anteversion was 19 degrees with 93% within the target range of 10 degrees to 25 degrees . Postoperative leg length discrepancy averaged 3 +/- 2 mm (range, 0-26 mm). Three patients sustained dislocations for an overall dislocation rate of 0.61%, and no patients required revision surgery for recurrent dislocation. There were 17 operative complications, including one deep infection, three wound infections, one transient femoral nerve palsy, three greater trochanter fracture, two femoral shaft fractures four calcar fractures, and three ankle fractures. Operative time averaged 75 minutes (range 40-150 minutes), and the average blood loss was 350 mL (range, 100-1300 mL). The mean hospital stay was 3 days (range, 1-17 days). The anterior approach on the orthopaedic table is a minimally invasive technique applicable to all primary hip patients. This technique allows accurate and reproducible component positioning and leg-length restoration and does not increase the rate of hip dislocation. Therapeutic study, Level IV-1 (case series). See the Guidelines for Authors for a complete description of levels of evidence.

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The use of an artificial femoral head for arthroplasty of the hip joint.

R Judet, J JUDET (1950)

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Mini-incision anterior approach does not increase dislocation rate: a study of 1037 total hip replacements.

Thierry Siguier, Marc Siguier, Bertrand Brumpt (2004)

Correct positioning of the prosthetic components in total hip replacements is important to prevent dislocations. Correct positioning is made easier by extensive approaches, but it also is possible using the mini-incision approach. The mini-incision used to facilitate early rehabilitation should not produce a higher dislocation rate than that of the more conventional approaches. The anterior surgical approach we describe allows for good exposure, despite the reduced size of the skin incision. Its length is 5-10 cm and usually 6-8 cm for patients with normal corpulence. Our mini-incision anterior approach using intermuscular planes allows a surgical approach to the hip and implantation of a total prosthesis with no muscle, tendon, or trochanteric section, even partially. This is not possible with any other surgical approach. A series of 1037 primary total hip replacements done between June 1993 and June 2000 was studied retrospectively. The dislocation rate was 0.96% (10 of 1037 hips). The mini-incision approach allows for adequate positioning of the two prosthetic components. Preserving the muscular potential also may contribute to dynamic stabilization of the hip.

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Author and article information

Contributors

Maximilian Rudert: +49 931 803 1101 , m-rudert.klh@uni-wuerzburg.de

Konstantin Horas: k-horas.klh@uni-wuerzburg.de

Maik Hoberg: m-hoberg.klh@uni-wuerzburg.de

Andre Steinert: a-steinert.klh@uni-wuerzburg.de

Dominik Emanuel Holzapfel: dominikholzapfel@icloud.com

Stefan Hübner: stefan-huebner@uni-wuerzburg.de

Boris Michael Holzapfel: +49 931 803 3122 , holzapfel@orthopaedic-oncology.net

Journal

Journal ID (nlm-ta): BMC Musculoskelet Disord

Journal ID (iso-abbrev): BMC Musculoskelet Disord

Title: BMC Musculoskeletal Disorders

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2474

Publication date (Electronic): 3 February 2016

Publication date PMC-release: 3 February 2016

Publication date Collection: 2016

Volume: 17

Electronic Location Identifier: 57

Affiliations

[ ]Department of Orthopaedic Surgery, University of Wuerzburg Koenig-Ludwig Haus, Brettreichstr. 11, 97074 Wuerzburg, Germany

[ ]Dapartment of Trauma, Orthopaedics, Hand and Reconstructive Surgery, Clinic Harlaching, Sanatoriumsplatz 2, 81545 Munich, Germany

[ ]Institute of Anatomy and Cell Biology, University of Wuerzburg, Koellikerstr. 6, 97070 Wuerzburg, Germany

[ ]Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD 4049 Brisbane, Australia

Article

Publisher ID: 908

DOI: 10.1186/s12891-016-0908-z

PMC ID: 4741054

PubMed ID: 26843069

SO-VID: 96109e02-682a-4119-9ada-1f4ad3bcadf4

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 16 September 2015

Date accepted : 27 January 2016

Custom metadata

ScienceOpen disciplines: Orthopedics

Keywords: direct anterior approach,hueter interval,minimally-invasive,hip replacement,perforator,anatomical landmark

Data availability:

ScienceOpen disciplines: Orthopedics

Keywords: direct anterior approach, hueter interval, minimally-invasive, hip replacement, perforator, anatomical landmark

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The Wuerzburg procedure: the tensor fasciae latae perforator is a reliable anatomical landmark to clearly identify the Hueter interval when using the minimally-invasive direct anterior approach to the hip joint

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Abstract

Background

Methods and Surgical Technique

Conclusion

Related collections

Orthopedics

Most cited references 22

Single-incision anterior approach for total hip arthroplasty on an orthopaedic table.

The use of an artificial femoral head for arthroplasty of the hip joint.

Mini-incision anterior approach does not increase dislocation rate: a study of 1037 total hip replacements.

Author and article information

Contributors

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Article

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Cited by 6

Most referenced authors 186