The anatomy of the anterior approach : a cadaver study

BACKGROUND : This research investigated the anatomy underlying minimally invasive total hip arthroplasty when the anterior approach was used. METHODS : Ninety hips were dissected and in one cadaver, a complete hip replacement was performed. Simulations of the anterior approach surgical incisions were carried by the orthopaedic surgeon in order to see if injury to the lateral femoral cutaneous nerve (LFCN) could be avoided, when the correct anatomical landmarks were palpated. RESULTS : The data analysis revealed significant differences for the mean distances from the pubic tubercle to the straight head of the rectus femoris muscle. Statistical significance was detected for comparisons between males and females, for weight ranges and BMI categories. CONCLUSION : The study findings prove that the concerns relating to the course and distribution pattern of the LFCN and the lateral circumflex femoral artery (LCFA) using the anterior approach, could be overcome when the anatomy of the hip joint and the thigh is understood. However, it is important to note the possible variations in the course of the LFCN and the branching pattern of the LCFA in order to avoid intra-operative bleeding and possible thigh numbness post-surgery.https://www.saoa.org.za/publications/saojam2018Anatom