CHAPTER 35 Surgical Approach
Direct Anterior Revision
KEY POINTS
The direct anterior approach leaves the abductor muscles intact and has the potential to minimize the risk of gluteal insufficiency.
Access to the cup is usually possible through a minimal approach comparable to that in primary total hip arthroplasty.
A partial release of the tensor fasciae latae muscle’s origin gives straight access to the femur for endofemoral procedures.
TECHNIQUE
Skin Incision
Although it is recommended to place the skin incision further laterally than in the original Smith-Petersen version, the incision can be easily extended proximally analogously. It will not be placed directly above the iliac crest but will extend the original incision laterally parallel to the iliac crest. Usually it is necessary only to detach the origin of the TFL partially from the ilium. Therefore a proximal extension of the skin incision to the level of the anterior superior iliac spine (ASIS) or slightly proximal to it is sufficient (Fig. 35-1).