David G. Lewallen
KOLOA, Hawaii — At Orthopedics Today Hawaii, a speaker said surgeons should make the anterolateral approach extensile when it is used for primary total hip arthroplasty.
“[Take] your approach and make it extensile, both to get out of trouble during complex primary and to allow you to do revision with the same basic approach,” David G. Lewallen, MD, said during his presentation.
He said with anterolateral or direct approaches for THA, risks include numbness, fractures and infection, but these are all manageable.
Lewallen said the anterolateral approach is a good approach for primary THA.
“[It is an] excellent approach, excellent exposure on the acetabulum and helps us manage major bone loss problems,” he said.
With the acetabular exposure, surgeons can see everything circumferentially, according to Lewallen.
“A curved implant is easier with this approach, like I think it is with most anteriorly based approaches,” he said. “Having an implant that allows you to slip around the corners is an advantage. Here’s the problem — the muscle tries to push you into varus, but also into flexion. It doesn’t matter so much with a cementless implant but if you put a cemented implant in this fashion, you can have a void in the cement and early loosening from malposition.”
Lewallen said surgeons should have an extended osteotomy version of whatever approach they decide to use for primary and revision THA, such as the Wagner approach.
“It’s invaluable for removing well-fixed, excessively coated implants or for getting lots of cement out and allowing you protect the diaphysis you need for fixation, generally for revision,” he said. – by Monica Jaramillo
Lewallen DG. Why I use the anterolateral approach for primary THA and how to make it extensile. Presented at: Orthopedics Today Hawaii; Jan. 12-16, 2020; Koloa, Hawaii.
Disclosure: Lewallen reports no relevant financial disclosures.