Anterior-Based Muscle-Sparing Approach in the Lateral Position
Introduction
Variation of Watson-Jones approach described in 1938, anterior-based muscle-sparing approach (ABMS) approach first described in 2004 by Bertin and Rottinger
Intermuscular interval between the tensor fascia latae (TFL) and abductor muscles
Performed in the lateral decubitus position
Surgical Technique
Positioning
Figure 1Photograph shows, after the patient is prepped and draped, the foot of the bed being dropped to allow for extension and external rotation of the surgical hip.
Standard operating table with the patient in the lateral decubitus position and the surgical hip up
The author prefers to use a peg board for positioning
The hip should be able to achieve 100° of flexion, 15° of extension, and 25° to 30° of internal and external rotation without impingement
Antiseptic prep solution and draping per surgeon preference
Lower the foot of the bed to facilitate extension and external rotation of the surgical limb (Figure 1)
A vascular roll or blankets can be used to abduct the extremity providing relaxation of the TFL and gluteus medius
Approach
Figure 2Intraoperative photograph shows that a line connecting the anterior superior iliac spine and the greater trochanter should pass through the midpoint of the incision.
Figure 4Intraoperative photograph shows the initial subcapital femoral neck osteotomy made using a reciprocating saw.
Figure 5Intraoperative photograph shows the final femoral neck osteotomy made using the saddle (superior red circle) or the lesser trochanter (inferior red circle) as reference points.
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