“Anterolateral” approach to the hip: a systematic review of the correct definition of terms

Abstract

Purpose: The Watson-Jones interval plane between tensor fascia lata (TFL) and the gluteus medius (GM) has come back into fashion in the past few years - Röttinger described the anterolateral minimal invasive approach (ALMI) for use in total hip replacement, in which the standard Watson-Jones interval was used, but with a completely intermuscular plane. However, the term anterolateral is often still utilised to describe intramuscular approaches in which the GM was violated, thus creating a potential misunderstanding in the literature. Accordingly, we have designed a study to answer the following questions: (1) are there articles in the recent literature that use the term “anterolateral” to describe different approaches; (2) which would be the correct description of the anterolateral approach? Methods: We did a systematic review of the literature based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, to look for peer reviewed papers of any evidence level focusing on the definition of anterolateral approach; MEDLINE and EMBASE were searched. Results: 73 manuscripts met the criteria of the systematic search. 53 papers (72.6%) reported the term anterolateral approach to describe a complete intermuscular approach between the interval between GM and TFL. Nonetheless, in the remaining 20 papers (27.4%) the term anterolateral was used to describe intramuscular approaches in which the gluteus medius was violated. Conclusion: In about 1 out of 4 papers in the recent literature, the term anterolateral was utilised to describe approaches that are completely different both in terms of anatomy and function.

German surgeons’ technical preferences for performing total hip arthroplasties: a survey from the National Endoprosthesis Society

“…Moreover, the anterolateral approach is not performed uniformly, by all surgeons. In about one out of four papers in recent literature, the term anterolateral approach was used to describe different approaches in terms of anatomy and function [25]. These inconsistencies of the literature make consistent or uniform statements about MIS or surgical approaches difficult to interpret.…”

The Association of Body Mass Index with Surgical Time Is Mediated by Comorbidity in Patients Undergoing Total Hip Arthroplasty

“…Eventually, 748 patients affected by primary hip OA were enrolled in the study. All procedures were performed by the same surgical team for prosthetics through an anterior-based muscle-sparing (ABMS) supine approach ( Figure 1 ) [ 42 ]. A cementless standard hemispherical cup and a Corail-design cementless stem were implanted.…”

Muscle strength changes following different surgical approaches used in primary total hip arthroplasty: A Systematic Review and Meta-analysis

“…Watson-jones -This approach was fir st described by Sayer (1874), and popularised by Watson-jones (1936) [98,127,128] .…”

“…It is evident from tables 7 and 8 that methods used in study protocols, including testing position, equipment, strength outcome measures used, and reporting, are not consistent in the included studies. To reduce the variance in the analysis, results were grouped according to the surgical approach as defined in table - [76,-82] were reclassified from anterolateral approach to lateral approach due to the classic Watson-Jones approach or abductor tenotomy or violation of gluteus medius [98] .…”