Understanding Iliotibial Band-Sparing Total Hip Arthroplasty: Alternatives to Traditional THA Approaches
Keywords:iliotibial band, total hip arthroplasty, minimally invasive
Excellent long term results in total hip arthroplasty (THA are achievable through a variety of surgical techniques. However, the push for cost savings and higher patient expectations has shifted the focus to improving short term outcomes such as length of stay and in-hospital narcotic requirements. While approximately 87% of surgeons worldwide continue to prefer traditional posterolateral (PL) or lateral approaches for arthroplasty,1alternative approaches that spare the iliotibial band have emerged over the last several years in hopes of improved outcomes. This review explores the iliotibial band-sparing approaches, their advantages and disadvantages, and provides an overview of their published results.
Chechik O, Khashan M, Lador R, Salai M, Amar E. Surgical approach and prosthesis fixation in hip arthroplasty world wide. Arch Orthop Trauma Surg. 2013;133(11):1595-1600.
Huang BK, Campos JC, Michael Peschka PG, et al. Injury of the gluteal aponeurotic fascia and proximal iliotibial band: anatomy, pathologic conditions, and MR imaging. Radiographics. 2013 Sep-Oct;33(5):1437-52.
Evans P. The postural function of the iliotibial tract. Ann R Coll Surg Engl. 1979;61(4):271-280.
Flato R, Passanante GJ, Skalski MR, Patel DB, White EA, Matcuk GR. The iliotibial tract: imaging, anatomy, injuries, and other pathology. Skeletal Radiol. 2017;46(5):605-622.
Fairclough J, Hayashi K, Toumi H, et al. The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. J Anat. 2006;208(3):309-316. doi:10.1111/j.1469-7580.2006.00531.x.
Inman, V. Functional Aspects of the Abductor Muscles of the Hip. J Bone Jt Surgery-American Vol. 29(3):607-619, July 1947.
Müller M, Schwachmeyer V, Tohtz S, et al. The direct lateral approach: Impact on gait patterns, foot progression angle and pain in comparison with a minimally invasive anterolateral approach. Arch Orthop Trauma Surg. 2012;132(5):725-731.
Rachbauer F, Kain MSH, Leunig M. The History of the Anterior Approach to the Hip. Orthop Clin North Am. 2009;40(3):311-320.
Smith-Petersen MN: A new supra-articular subperiosteal approach to the hip joint. Am J Orthop Surg (Phila Pa) 1917;15:593.
Light TR, Keggi KJ: Anterior approach to hip arthroplasty. Clin Orthop Relat Res 1980;152:255-260.
Post ZD, Orozco F, Diaz-Ledezma C, et al. Direct Anterior Approach for Total Hip Arthroplasty: Indications, Technique, and Results. J Am Acad Orthop Surg. 2014;22(9):595-603.
Leunig M, Faas M, von Knoch F, et al. Skin crease 'bikini' incision for anterior approach total hip arthroplasty: surgical technique and preliminary results. Clin Orthop Relat Res. 2013 Jul;471(7):2245-52.
Rodriguez JA, Cooper HJ, Robinson J. Direct anterior approach to THR: what it is and what it is not. Curr Rev Musculoskelet Med. 2013 Dec;6(4):276-8.
Meneghini RM, Pagnano MW, Trousdale RT, Hozack WJ. Muscle damage during MIS total hip arthroplasty: Smith-Petersen versus posterior approach. Clin Orthop Relat Res. 2006 Dec;453:293-8
Barrett WP, Turner SE, Leopold JP. Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty. J Arthroplasty. 2013;28(9):1634-1638.
Restrepo C, Parvizi J, Pour AE, et al. Prospective Randomized Study of Two Surgical Approaches for Total Hip Arthroplasty. J Arthroplasty. 2010;25(5):671-679.
Berend KR, Lombardi A V, Seng BE, et al. Enhanced Early Outcomes with the Anterior Supine Intermuscular Approach in Primary Total Hip Arthroplasty. J Bone Jt Surgery-American Vol. 2009;91(Suppl 6):107-120.
Martin CT, Pugely AJ, Gao Y, et al. A comparison of hospital length of stay and short-term morbidity between the anterior and the posterior approaches to total hip arthroplasty. J Arthroplasty. 2013;28(5):849-854.
Meermans G, Konan S, Das R, et al. The direct anterior approach in total hip arthroplasty. Bone Joint J. 2017;99-B(6):732-740.
Yue C, Kang P, Pei F. Comparison of Direct Anterior and Lateral Approaches in Total Hip Arthroplasty: A Systematic Review and Meta-Analysis (PRISMA). Medicine (Baltimore). 2015;94(50):e2126.
Zhao H-Y, Kang P-D, Xia Y-Y, Shi X-J, Nie Y, Pei F-X. Comparison of Early Functional Recovery After Total Hip Arthroplasty Using a Direct Anterior or Posterolateral Approach: A Randomized Controlled Trial. J Arthroplasty. 2017.
Schweppe ML, Seyler TM, Plate JF, Swenson RD, Lang JE. Does surgical approach in total hip arthroplasty affect rehabilitation, discharge disposition, and readmission rate? Surg Technol Int. 2013;23:219-227.
Poehling-Monaghan KL, Kamath AF, Taunton MJ, Pagnano MW. Direct Anterior versus Miniposterior THA With the Same Advanced Perioperative Protocols: Surprising Early Clinical Results. Clin Orthop Relat Res. 2014;473(2):623-631.
Rodriguez JA, et al. Does the direct anterior approach in THA offer faster rehabilitation and comparable safety to the posterior approach? Clin Orthop Relat Res. 2014 Feb;472(2):455-63.
Barton C, Kim PR. Complications of the direct anterior approach for total hip arthroplasty. Orthop Clin North Am. 2009;40(3):371-375.
Masonis J, Thompson C, Odum S. Safe and accurate: learning the direct anterior total hip arthroplasty. Orthopedics. 2008;31(12 Suppl 2).
Matta JM, Shahrdar C, Ferguson T. Single-incision Anterior Approach for Total Hip Arthroplasty on an Orthopaedic Table. Clin Orthop Relat Res. 2005;441(NA;):115-124.
Purcell RL, Parks NL, Gargiulo JM, Hamilton WG. Severely Obese Patients Have a Higher Risk of Infection Following Direct Anterior Approach Total Hip Arthroplasty. J Arthroplasty. 2016:2-5.
Woolson ST, Pouliot MA, Huddleston JI. Primary Total Hip Arthroplasty Using an Anterior Approach and a Fracture Table. Short-term Results From a Community Hospital. J Arthroplasty. 2009;24(7):999-1005.
de Steiger RN, Lorimer M, Solomon M. What Is the Learning Curve for the Anterior Approach for Total Hip Arthroplasty? Clin Orthop Relat Res. 2015;473(12):3860-3866.
Barnett SL, Peters DJ, Hamilton WG, Ziran NM, Gorab RS, Matta JM. Is the Anterior Approach Safe? Early Complication Rate Associated With 5090 Consecutive Primary Total Hip Arthroplasty Procedures Performed Using the Anterior Approach. J Arthroplasty. 2016;31(10):2291-2294.
Jewett BA, Collis DK. High complication rate with anterior total hip arthroplasties on a fracture table. Clin Orthop Relat Res. 2011;469(2):503-507.
Molenaers B, Driesen R, Molenaers G, Corten K. The Direct Anterior Approach for Complex Primary Total Hip Arthroplasty: The Extensile Acetabular Approach on a Regular Operating Room Table. J Arthroplasty. 2017;32(5):1553-1559.
Mirza AJ, Lombardi A V., Morris MJ, Berend KR. A mini-anterior approach to the hip for total joint replacement: Optimising results: Improving hip joint replacement outcomes. Bone Jt J. 2014;96B(11):32-35.
Sendtner E, Borowiak K, Schuster T, Woerner M, Grifka J, Renkawitz T. Tackling the learning curve: Comparison between the anterior, minimally invasive (Micro-hip®) and the lateral, transgluteal (Bauer) approach for primary total hip replacement. Arch Orthop Trauma Surg. 2011;131(5):597-602.
Amanatullah DF, Masini MA, Roger DJ, Pagnano MW. Greater inadvertent muscle damage in direct anterior approach when compared with the direct superior approach for total hip arthroplasty. Bone Joint J. 2016 Aug;98-B(8):1036-42.
Murphy SB, Ecker TM. THA Performed using Conventional and Navigated Tissue-preserving Techniques. 2006;(453):160-167.
Wellman SS, Murphy AC, Gulcynski D, Murphy SB. Implementation of an accelerated mobilization protocol following primary total hip arthroplasty:
Impact on length of stay and disposition. Curr Rev Musculoskelet Med. 2011;4(3):84-90.
Capuano N, Del Buono A, Maffulli N. Tissue preserving total hip arthroplasty using superior capsulotomy. Oper Orthop Traumatol. 2015;27(4):334-341.
Penenberg BL, Bolling WS, Riley M. Percutaneously assisted total hip arthroplasty (PATH): a preliminary report. J Bone Joint Surg Am. 2008 Nov;90 Suppl 4:209-20.
Rasuli KJ, Gofton W. Percutaneously assisted total hip (PATH) and Supercapsular percutaneously assisted total hip (SuperPATH) arthroplasty: learning curves and early outcomes. Ann Transl Med. 2015;3(13):179.
Chow JC, Della Torre PK, Fitch DA. SuperPATH and Micro-superior Total Hip Arthroplasty. In: Scuderi GR, Tria AJ, eds. Minimally Invasive Surgery in
Orthopedics. Cham: Springer International Publishing; 2016:541-552.
Della Torre PK, Fitch DA, Chow JC. Supercapsular percutaneously-assisted total hip arthroplasty: radiographic outcomes and surgical technique. Ann Transl Med. 2015;3(13):180.
Chow J, Penenberg B, Murphy S. Modified micro-superior percutaneously-assisted total hip: Early experiences & case reports. Curr Rev Musculoskelet Med. 2011;4(3):146-150.
Gofton W, Fitch DA. In-hospital cost comparison between the standard lateral and supercapsular percutaneously-assisted total hip surgical techniques for total hip replacement. Int Orthop. 2016;40(3):481-485.
How to Cite
Copyright (c) 2018 Russell Nevins, Kevin M Sagers
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and License Agreement:
Authors who publish with the Reconstructive Review agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work. Reconstructive Review follows the Creative Commons Attribution-NonCommercial CC BY-NC. This license allows anyone to download works, build upon the material, and share them with others for non-commercial purposes as long as they credit the senior author, Reconstructive Review, and the Joint Implant Surgery & Research Foundation (JISRF). An example credit would be: "Courtesy of (senior author's name), Reconstructive Review, JISRF, Chagrin Falls, Ohio". While works can be downloaded and shared they cannot be used commercially.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.