Note by Patricia Walter: Sometimes hip resurfacing surgeons are not specific when they are talking about the “anterior approach to surgery” since this can include the Direct Anterior Approach, the Anterolateral Approach and other variations. The surgeons using the posterior approach often refer to the “anterior approach” incorrectly to include all types of anterior approaches. Dr. Matta has written a comprehensive explanation of the Anterior Approach to explain the misinformation often presented.
The postings on your web site by some hip resurfacing surgeons is unfortunately giving false information about the Posterior vs Anterior approach. They are referring to the Anterior Approach in relation to what is now termed lateral approach through which the abductor tendons (gluteus medius and gluteus minimus muscles) are partially severed or detached from the femur. The approach they erroneously refer to as anterior is also known as the Harding Approach. By contradistinction the Anterior Approach follows the Smith-Petersen interval and is an inter muscular and inter nervus approach. It detaches neither the hip abductors nor the hip external rotators.
Surgeons also refer to repairing the hip capsule as a means to prevent dislocation but more important resistance to hip dislocation comes from the external rotator muscles, particularly the obturator externus muscle and these tendons are severed with the Posterior Approach. The external rotator muscles actively center the femoral head while the large gluteal muscles provide the power. The external rotator muscles also power hip rotation which is important for a number of sport activities including golf, tennis, skiing and martial arts.
Anterior Approach Resurfacing is possible and I believe preferable over posterior approach because of it’s muscle sparing aspects. Also with the Anterior Approach the patient is supine during surgery as opposed to lateral with Posterior Approach. Supine position facilitates intra operative checks of acetabular and femoral component position with x-ray which can improve accuracy.Certainly whether Anterior or Posterior Approach is a better way to perform Hip Resurfacing is a matter of medical opinion. Please understand however, that the point I am making is that some hip resurfacing surgeons discussion does not relate to Anterior Approach as presented at the 2008 Resurfacing Course or what patients find when they “Google” Anterior Approach. Sincerely, Joel M. Matta, MD Director, Hip and Pelvis Institute St John’s Health Center, Santa Monica, Ca www.hipandpelvis.com