Minimally invasive anterolateral (Watson-Jones) approach in the lateral decubitus physician

Abstract

The current interest in minimally invasive total hip arthroplasty stems from the potential to improve postoperative recovery. This is accomplished by utilizing mobile windows to reduce soft tissue trauma and preserve intact musculotendinous units. Minimally invasive techniques have been developed for the anterolateral (Hardinge) and posterior approaches with each retaining respective advantages and disadvantages. Many surgeons prefer the Hardinge approach due to the historically lower dislocation rate when compared with posterior surgery. However, the necessary violation of the anterior abductor insertion on the greater trochanter can result in weakness and gait alteration in some patients. The desire to minimize postoperative dislocation risk while maximizing functional recovery and maintenance of abductor strength has led to the development of the minimally invasive Watson-Jones approach. The objective of this chapter is to describe the surgical technique in detail. This challenging approach uses a combination of new instrumentation and positioning which, while more difficult than the classic Watson-Jones approach, aims to provide patients with a low risk of dislocation, improved maintenance of abductor strength, and more rapid rehabilitation without compromising long-term outcomes.