Hip resurfacing using the anterolateral Watson-Jones approach in the supine position

Hip resurfacing is commonly performed using a posterior approach, although some authors have advocated damage to the vascular supply due to posterolateral capsulectomy as one of the possible causes of femoral neck fracture. The need to preserve blood supply has led to the use of an alternative surgical vascular-sparing procedure. This article describes early clinical and radiological outcomes of hip resurfacing via an anterolateral Watson-Jones approach in the supine position. Twenty-eight hips in 26 patients with degenerative hip disease were evaluated retrospectively with a mean follow-up of 28 months (range, 12-61 months). The mean age at surgery was 58 years (range, 26-72 years). The average Harris Hip Score increased from 60 points preoperatively (range, 30-69 points) to 96 points at latest follow-up (range, 80-100 points). Complications included femoral neurapraxia and deep vein thrombosis in 1 patient, which both resolved. One hip required revision due to acetabular cup loosening 15 months postoperatively. No progressive radiolucencies, avascular necroses, or dislocations were observed. Heterotopic ossifications were detected in 3 hips. The absence of early femoral failures in our series may be related to careful patient selection and a proper surgical technique. The anterolateral Watson-Jones approach in the supine position provides optimal exposure of the acetabulum and proximal femur, but a wide soft tissue release is always necessary. We preserve the posterolateral neck capsule to improve the chances of maintaining the blood supply to the femoral neck, even if no differences in clinical outcomes and complications are evident between the anterolateral and posterolateral approaches.