Surgical Tips and Tricks for the Anterior-Based Muscle-Sparing Approach During Total Hip Arthroplasty

In orthopaedic surgery, the advancement of surgical techniques aims to enhance patient outcomes and minimize postoperative complications. A notable innovation in this field is the anterior-based muscle-sparing (ABMS) approach to total hip arthroplasty, also known as ABLE or Rottinger approach. ABMS modifies the Watson-Jones approach, using the intermuscular plane between the tensor fascia lata and the gluteus medius to access the hip joint without detaching abductor muscles. This technique offers several benefits including muscle preservation, decreased pain, faster recovery, and lower dislocation rates, similar to the direct anterior approach. However, ABMS distinguishes itself by its lower infection rate, reduced nerve injury risk, easier femoral exposure, and compatibility with various implants. Large-scale studies have confirmed its safety and effectiveness. While mastering the ABMS technique requires some learning, this article provides a concise description of the technique, along with practical insights gained from surgical experience to support safe and effective execution.