title: MAASH Technique for Total Hip Arthroplasty: A Capsular Work.
abstract: BACKGROUND
  Dislocation and leg length discrepancy are major complications following total hip arthroplasty (THA). Many surgical approaches for THA have been described, but none suggest a capsular incision that assures good exposure while maintaining adequate capsule integrity in closure.
  
  
  OBJECTIVE
  Modified anterolateral approach for stable hip (MAASH) is a modification of the classical Hardinge approach, but specifically preserves the anterior iliofemoral lateral ligament and pubofemoral ligament excising the "weak area" of the capsule, in the so called "internervous safe zone" and introducing the "box concept" for the anterior approach to the hip. This is the main difference of the MAASH approach. This technique can be used as a standard for all THA standard models, but we introduce new devices to make it easier.
  
  
  METHODS
  From November 2007 to May 2012, data were collected for this observational retrospective consecutive case study. We report the results of 100 THA cases corresponding to the development curve of this new concept in THA technique.
  
  
  RESULTS
  MAASH technique offers to hip surgeons, a reliable and reproducible THA anterolateral technique assuring accurate reconstruction of leg length and a low rate of dislocation. Only one dislocation and six major complications are reported, but most of them occurred at the early stages of technique development.
  
  
  CONCLUSIONS
  MAASH technique proposes a novel concept on working with the anterior capsule of the hip for the anterolateral approach in total hip arthroplasty, as well as for hemiarthroplasty in the elderly population with high dislocation risk factors. MAASH offers maximal stability and the ability to restore leg length accurately.
authors.affiliation: Orthopedic and Trauma Department of the Hospital de Sant Celoni, Av. Hospital, 19, 08470 Sant Celoni, Barcelona, Catalonia Spain ; Arthrocat SLP, Group of Orthopedic Surgery and Sports Medicine, Sant Celoni, Spain.
authors.forename: Felipe G
authors.initials: FG
authors.lastname: Delgado
authors.forename: Albert
authors.initials: A
authors.lastname: Broch
authors.forename: Francisco
authors.initials: F
authors.lastname: Reina
authors.forename: Lluís
authors.initials: L
authors.lastname: Ximeno
authors.forename: David
authors.initials: D
authors.lastname: Torras
authors.forename: Francesc
authors.initials: F
authors.lastname: García
authors.forename: Antoni
authors.initials: A
authors.lastname: Salvador
keywords: THA stability; anterior hip capsule; hip approach; hip arthroplasty; hip capsule anatomy; leg length discrepancy