title: Distal Extension of the Direct Anterior Approach to the Hip: A Cadaveric Feasibility Study.
abstract: The direct anterior approach (DAA) is becoming more popular as the standard surgical approach for primary total hip arthroplasty. However, femoral complications of up to 2.8% have been reported. Therefore, it is important for surgeons to understand the periarticular neurovascular anatomy in order to safely deal with intraoperative complications.
  
  
  
  Anatomic dissections were performed on 20 cadaveric hips. The neurovascular structures anterior to the femur and distal to the intertrochanteric line were dissected and its position was described in relation to anatomic landmarks easily identified through the DAA: anterior superior iliac spine (ASIS), the insertion of the gluteus minimus (GM), and the lesser trochanter (LT).
  
  
  
  Two clearly distinguishable neurovascular bundles running to the vastus lateralis were seen in 17 of 20 specimens. The average distances to the landmarks were as follows: ASIS-1st bundle = 12.3 cm (range, 9.7-14.5); GM-1st bundle = 3.2 cm (range, 2.2-4); LT-1st bundle = 1.6 cm (range, 0.7-2.8); 1st bundle-2nd bundle = 3.3 cm (range, 1.8-6.1).
  
  
  
  A consistent pattern of 2 clearly distinguishable neurovascular bundles was seen in 85% of the specimens. Knowledge of the position of these neurovascular bundles in relation to the anatomic landmarks makes distal femoral extension of the DAA feasible. Further clinical studies are needed to confirm the safety of the extensile anterior approach.
authors: Department of Orthopaedic Surgery, University Hospitals Leuven-Pellenberg, Leuven, Belgium.
authors: Stijn G M
authors: SG
authors: Ghijselings
authors: Department of Orthopaedic Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors: Ronald
authors: R
authors: Driesen
authors: Department of Orthopaedic Surgery, University Hospitals Leuven-Pellenberg, Leuven, Belgium.
authors: Jean-Pierre
authors: JP
authors: Simon
authors: Department of Orthopaedic Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors: Kristoff
authors: K
authors: Corten
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059925:Anatomic Landmarks; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D002102:Cadaver; D005240:Feasibility Studies; D005260:Female; D006615:Hip / Q000098:blood supply / Q000294:innervation / Q000601:surgery*; D006621:Hip Joint / Q000098:blood supply / Q000294:innervation / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D052097:Quadriceps Muscle / Q000098:blood supply / Q000294:innervation / Q000601:surgery*
keywords: anterior approach; direct anterior approach; hip; revision hip arthroplasty; total hip arthroplasty; vastus lateralis