The Anterior-Based Muscle-Sparing Approach to Total Hip Arthroplasty

242 Pages·2022·16.953 MB·English

by  Jeffrey A. Geller (editor), Brian J. McGrory (editor)

The Anterior-Based
Muscle-Sparing
Approach to Total Hip
Arthroplasty
Jeffrey A. Geller
Brian J. McGrory
Editors
123
The Anterior-Based Muscle-Sparing
Approach to Total Hip Arthroplasty
Jeffrey A. Geller • Brian J. McGrory
Editors
The Anterior-Based
Muscle-Sparing
Approach to Total Hip
Arthroplasty
Editors
Jeffrey A. Geller Brian J. McGrory
Department of Orthopedic Surgery Department of Orthopedic Surgery
New York Presbyterian-Columbia Tufts University School of Medicine
University Irving Medical Center and Maine Medical Center
New York, NY, USA Falmouth, ME, USA
ISBN 978-3-031-02058-2 ISBN 978-3-031-02059-9 (eBook)
https://doi.org/10.1007/978-3-031-02059-9
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
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I want to dedicate this book to my parents, Herbert Geller
(1928–2010) and Elisabeth Geller (1936– ), who instilled in me
my core values and work ethic, and taught me to never give up.
And by the way, go Yankees.
– Jeffrey A. Geller
For my father John P. McGrory (1938–2021) and my brother
John J. McGrory (1962–2021), two of the greatest teachers
I have ever known.
– Brian J. McGrory
Foreword
Orthopedic surgery is filled with numerous examples of great paradox.
As a collective, we view ourselves as innovators, desire new and improved
devices, technology, and protocols. At the same time, the paradox is that these
same surgeons are often the most resistant to innovation and improvements in
surgical technique.
The Anterior Based Muscle Sparing Approach to Total Hip Arthroplasty is
an extremely important and timely contribution to orthopedic practice.
While there have been numerous innovations in our devices and materials,
surgeons have traditionally had difficulty learning improved muscle sparing
techniques. Younger surgeons often don’t realize that total hip replacement
started with trochanteric osteotomy for exposure and abductor tensioning;
however, just as early in history, Maurius Smith-Peterson developed an exten-
sile direct anterior approach for cup arthroplasty. Various other anterior
approaches were used for treatment of hip infection and fracture including
the Watson-Jones approach.
So, what is new?
The authors and editors should truly be congratulated for advancing surgi-
cal care through a detailed and clearly illustrated text showing the most
detailed and descriptive forms of this surgical approach. With the knowledge
from this text, surgeons will be safer, more facile, and cause less tissue
trauma, while allowing use of the most modern implants and bearing
surfaces.
This book is a must have for practicing surgeons, especially those moving
to anterior procedures, and certainly for residents and fellows in training. The
detail and clarity in technique, as well as beautiful photos, are integral to our
learning the ABMS approach.
In addition, those surgeons using this ABMS approach are certain to learn
a tip or trick to make routine exposures easier, and complex exposures
possible.
Andrew A. Freiberg, MD
Newton-Wellesley Hospital, Newton, MA, USA
Mass General Brigham Health, Boston, MA, USA
Former Chief Medical Officer, Zimmer Biomet, Warsaw, IN, USA
vii
Preface
Total hip arthroplasty (THA) surgery has endured a long journey through his-
tory. The earliest experiences started in the 1920s with several different
poorly designed implants such as the cup arthroplasty with porcelain, the
low-friction arthroplasty using Teflon cups, and the catastrophes of metal-on-
metal articulations. These utter failures have humbled us to continue to search
for better implant designs and have compelled us to improve and develop the
current generation of modern implants which have now been shown to sur-
vive beyond 25–30 years.
In addition to the advancements in implant materials over the last few
decades, surgical approach has been less recognized but equally impactful in
the way modern hip replacement surgery has improved. What started out as a
surgical procedure that led to well over a liter of blood loss, a prolonged inpa-
tient hospital stay, a near-guaranteed blood transfusion, a very high rate of
complications, and close to a year’s worth of recovery, THA has now evolved
into a potentially outpatient procedure with a relatively minimal time to
recover.
In 2004, one of the co-editors (BJM) served as the chairperson of the
American Association of Hip and Knee Surgeons taskforce on minimally
invasive (MIS) total joint arthroplasty, just as various different surgical tech-
niques were being first introduced. The group concluded that such surgeries
are “of great interest to patients, joint replacement surgeons, and third- party
payers” and that “this interest is based on the promise of same or better long-
term results with shorter and less painful recovery.” As early as 2004, which
also happened to coincide with one of Dr. Röttinger’s first descriptions of this
modification of the Watson-Jones surgical interval, the committee noted that
proof for this optimism was not yet available at the time and stated that sup-
portive scientific evidence and rigorous evaluation of such newer techniques
were warranted.
The anterior-based muscle sparing (ABMS) approach to the hip is yet
another step in the evolution of this truly life-changing intervention of
THA. Just consider how surgical approach can dramatically affect a patients’
post-operative recovery and ultimate outcome, and how that has changed the
expectations of patients today.
This textbook contains an incredible wealth of information and experi-
ence, put forth by some of the pioneers who have learned this surgical
approach and developed their techniques with little to no formal framework
or guidance. Though the ABMS approach has been utilized in different
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x Preface
pockets around the world, this work marks the first collection and compen-
dium of information on this surgical approach. The reader will find a wealth
of information beginning with Dr. Röttinger’s early experience as he began to
popularize this unique surgical approach, the versatility of ABMS to be done
in either the supine or the lateral position, and how to avoid complications
through the “learning curve” and moving on to some of the most advanced
means of doing revision surgery through the ABMS approach. This is a com-
prehensive work of science that should afford even the novice hip surgeon the
tools to study and implement this technique into their surgical practice.
Our patients, of course, are the ultimate beneficiary of such a technique.
Along with substantial improvements in materials, pre-operative optimiza-
tion, and perioperative care, THA in the twenty-first century is very promis-
ing indeed. A primary goal of publishing this book was to summarize a
worldwide experience with the ABMS technique, describe nuances for pri-
mary and revision surgeries, and offer technical points, postoperative care,
and outcomes data – all in one place. Because of unclear nomenclature used
with the ABMS THA approach, it can be vexing to search in the usual litera-
ture databases to access all of this information. Previous descriptions of this
surgical approach include “Modified Watson-Jones,” “Röttinger Approach,”
“Abductor Sparing Watson-Jones,” “Anterolateral MIS,” or the “ABLE
approach,” all of which have been confusing and perhaps implying different
treatment of the surrounding musculature while approaching the hip joint.
The name “ABMS” approach was largely defined by one of our co-authors,
Dr. Scott Kelley, who recognized that the nomenclature was scattered and not
well delineated. Dr. Kelley was an early proponent of the ABMS approach,
who was not deterred by early skepticism from leaders in the anterior hip
establishment, and his perseverance is a big reason for the growing pool of
talented hip surgeons who utilize this surgical approach today.
In summary, this textbook is yet another small step in the continuing
improvement of surgical technique and outcome that we, as a specialty, have
further propelled during our years of research and practice. Our patients are
the true heroes who unknowingly have taught us where to steer, and how to
improve, upon reflection of their complications and adverse events, and we
are humbled by their strength each and every day.
New York, NY, USA Jeffrey A. Geller
Falmouth, ME, USA Brian J. McGrory
Acknowledgments
This textbook marks the culmination of over 20 years of education and expe-
rience in hip surgery. I have been fortunate in my career to train under and
work with some amazing individuals through my residency and fellowship.
In addition, I have had the pleasure of training some of the brightest residents
and fellows, who have taught me and influenced me as much over my career
as I have hopefully done for them. With every teaching conference and
research meeting, I am astonished at the bright and inquisitive minds that sur-
round me every day.
Additionally, I would like to acknowledge the thousands of patients who
have trusted the care of their hips to me over the years. Without their trust and
belief, I would never have developed the skill and experience needed to put
together a resource such as this work. I would also like to thank Dr. McGrory.
He has been a tremendous partner in this project. His hard work and incred-
ible wealth of knowledge have been a major part of the success of this book.
And of course, I could never have had a successful career without the
unwavering support of my family. My dearest wife Leigh, who has supported
me and my career from the early days of medical school through the rigors of
training and practice, she has shouldered the load of our family, and been a
beacon of love and strength for the last 25 years. And to my amazing kids,
Caroline, Henry, and Susie, who have developed into young adults that I
couldn’t be more proud of. Through all of the late nights, travel days away,
and weekends at meetings, their love and support has always kept me
grounded.
Jeffrey A. Geller
I am very grateful to the talented authors, surgeons, and colleagues whose
outstanding contributions have made this book possible. I also feel very for-
tunate for all of the patients that have taught me over the years, because it was
their beliefs and support that encouraged me to learn and hone the anterior-
based muscle sparing (ABMS) approach in my own practice. Brigham
McKenney, PA-C, has worked with me tirelessly in the operating room and
deserves great credit in my growth as an ABMS surgeon. Next, I would like
to thank my partners at Maine Medical Center (MMC), particularly George
Babikian, MD, and Adam Rana, MD. Dr. Babikian was not only the first to
employ this approach in Maine but also an indefatigable champion of this
variation of anterior total hip arthroplasty (THA). He is a gifted and generous
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xii Acknowledgments
teacher, outstanding leader, and – among many other accomplishments – the
force behind, and engineer of, outpatient THA at MMC. Dr. Rana leads the
MMC Joint Replacement Center research and outcomes program, and in
addition to being an exceptional ABMS surgeon and teacher, he has led the
team that has systematically analyzed our institutional data to add gravitas to
the evidence-based reasoning for adopting the ABMS approach. I would like
to also acknowledge the backing of Smith and Nephew, Inc. (Memphis, TN)
for ongoing institutional research support and also their steadfast commit-
ment to ABMS education nationally and internationally (ABLE advanced
anterior approach program). Thank you also to Springer Nature, for support-
ing this book, and Janakiraman Ganesan, for his role as project coordinator.
Finally, I sincerely thank Jeffrey Geller, MD, my co-editor in this undertak-
ing. Dr. Geller envisioned this book, kindly invited me to join him in the
project, and has been a fantastic partner in bringing it to fruition.
My family has sustained and supported me throughout my career, and for
this I am forever grateful. My wife Lori has been my biggest champion; for
the last 35 years, she has encouraged me to pursue my dreams and has done
all of the heavy lifting for our family as I chased them. Lori and my wonder-
ful sons Conor and Aidan have been a constant inspiration.
Brian J. McGrory