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General Orthopaedics


Current Concepts in Joint Replacement (CCJR) – Spring 2015


The anterior/Hueter approach to the hip was first described in 1883. It was then popularised in the 1940s by Judet in France using an orthopaedic positioning table which at the time was also used to treat a variety of orthopaedic injuries. In North America its use for joint replacements was limited to a few surgeons such as Kris Keggi in Connecticut using a regular surgical table as well as a select few surgeons (Joel Matta) who had trained with Emile Letournel, a student of Judet. It is fair to say that this anatomical approach to the hip was never forgotten but rather put aside as industry and clinicians focused on critical issues of implant breakage and failure as well as the larger problem of wear-related osteolysis. As we have made significant improvements in implant durability and fixation, the focus has now shifted on optimizing patient recovery and minimizing length of stay while providing the same quality of care. In these regards, the anterior approach provides a valid alternative to standard approaches to the hip due to its low risk of dislocation and minimal disruption to the musculature. In addition, the capacity of intra-operative imaging with the patient in the supine position provides assessment of component orientation as well as leg lengths. More importantly, like the advent of better instrumentation for the anterior approach, the use and optimization of the positioning table facilitates the execution of the anterior approach i.e. one assistant and no soft tissue release.