Matta's 2005 case series describes 494 consecutive primary THAs performed through a single-incision anterior approach on an orthopaedic table with intraoperative fluoroscopy. The study asks whether this muscle-sparing technique — operating through the Hueter internervous interval without detaching any muscle or tendon — allows reproducible component positioning and low dislocation rates in an unselected patient population.
The 0.61% dislocation rate in this series forces a direct comparison: posterior approach without repair runs 3.23% in the literature, and lateral approaches average 0.55% but carry a 4–20% postoperative limp rate from abductor disruption. The anterior approach sits at the favorable intersection — low dislocation and no abductor violation.
When a patient presents at high risk for instability (prior dislocation, neurologic condition, revision setting) or when early return to function is a priority, this paper provides the evidence base for choosing the anterior approach. The technical prerequisites are non-negotiable: orthopaedic table for controlled femoral positioning, intraoperative fluoroscopy for real-time cup verification, and offset broach handles to avoid posterior cortex perforation.
The one firm contraindication established here is a posterior acetabular defect requiring bone graft and plate fixation. Every other primary THA diagnosis was included.
Know the ankle fracture risk: external rotation torque during femoral dislocation can fracture the distal tibia or ankle in osteoporotic patients. Use a femoral head corkscrew or have an assistant apply direct rotation at the femoral condyles to offload the distal extremity.
Matta's 2005 case series describes 494 consecutive primary THAs performed through a single-incision anterior approach on an orthopaedic table with intraoperative fluoroscopy. The study asks whether this muscle-sparing technique — operating through the Hueter internervous interval without detaching any muscle or tendon — allows reproducible component positioning and low dislocation rates in an unselected patient population.
The 0.61% dislocation rate in this series forces a direct comparison: posterior approach without repair runs 3.23% in the literature, and lateral approaches average 0.55% but carry a 4–20% postoperative limp rate from abductor disruption. The anterior approach sits at the favorable intersection — low dislocation and no abductor violation.
When a patient presents at high risk for instability (prior dislocation, neurologic condition, revision setting) or when early return to function is a priority, this paper provides the evidence base for choosing the anterior approach. The technical prerequisites are non-negotiable: orthopaedic table for controlled femoral positioning, intraoperative fluoroscopy for real-time cup verification, and offset broach handles to avoid posterior cortex perforation.
The one firm contraindication established here is a posterior acetabular defect requiring bone graft and plate fixation. Every other primary THA diagnosis was included.
Know the ankle fracture risk: external rotation torque during femoral dislocation can fracture the distal tibia or ankle in osteoporotic patients. Use a femoral head corkscrew or have an assistant apply direct rotation at the femoral condyles to offload the distal extremity.