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A 67-year-old male with severe hip arthritis presents for evaluation of a total hip arthroplasty. The patient is requesting a minimally invasive Watson-Jones approach, as he has heard post-operative mobility is significantly improved compared with a traditional transgluteal technique. What should the patient be told to expect regarding early post-operative gait kinematics when comparing these surgical approaches?
The minimally invasive Watson-Jones approach results in improved gait velocity, cadence, and step length
There is no difference in early gait kinematics between the two approaches
The minimally invasive Watson-Jones approach results decreased gait velocity and stride length
The traditional transgluteal approach results in worse early gait kinematics
Early gait kinematics is dependent only on the type of prosthesis used, not surgical approach
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Despite the recent enthusiasm for minimally invasive hip surgery, there has been no proven benefit with regards to early post-operative gait kinematics when comparing the minimally invasive Watson-Jones approach with the more traditional transgluteal approach in total hip arthroplasty (THA).
The minimally invasive Watson-Jones approach involves making an incision 8cm in length from the anterior tubercle of the greater trochanter on a line running from the trochanteric crest to the anterior superior iliac spine (ASIS).The interval between the gluteus medius and the tensor fascia lata is then identified and an extra-articular exposure of the capsule can be obtained.
The traditional transgluteal approach involves making a longitudinal incision centered over tip of greater trochanter, followed by superficial dissection in which the fascia lata is split to expose tendon of gluteus medius. Deep dissection is carried out by making a longitudinal incision in fibers of gluteus medius, and then detaching the origin of gluteus minimus from anterior greater trochanter. Finally, exposure of the anterior joint capsule and capsulotomy can be completed.
Pospischill et al evaluated 20 patients who underwent a primary THA with use of a minimally invasive modified Watson-Jones approach compared with a group of 20 patients who underwent a THA with use of a standard transgluteal Hardinge approach. At 3 months, the authors found no significant benefit for patients who underwent a total hip arthroplasty through a minimally invasive Watson-Jones approach in comparison with those who were managed with a standard transgluteal approach.
Pfluger et al compared 50 conventional total hip replacements with 50 procedures performed using the minimally invasive anterolateral modification of the Watson-Jones approach in terms of blood loss and the duration of the operation. They found that both groups were virtually identical with respect to average blood loss and the duration of the procedure.
Pospischill M, Kranzl A, Attwenger B, Knahr K
J Bone Joint Surg Am. 2010 Feb;92(2):328-37. PMID: 20124059 (Link to Abstract)
Pospischill, JBJS 2010
Pflüger G, Junk-Jantsch S, Schöll V.
Int Orthop. 2007 Aug;31 Suppl 1:S7-11. PMID: 17668206 (Link to Abstract)
Pflüger, INTORT 2007
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In this video Dr. Krieger performs a minimally invasive anterolateral approach t...