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Published on: September 7, 2022
Applied anatomical study of direct anterior approach total hip arthroplasty: optimizing surgical procedures and
Xun Xu1,2, Jinzhong Ma3
1Changzhou Maternal and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, China.
Purpose:
To explore how to accurately perform direct anterior approach (DAA) total hip arthroplasty (THA) by identifying key anatomical landmarks to optimize surgical procedures and reduce complications.
Methods:
Twenty hip joints from 10 lower limb specimens were used to simulate DAA THA. The anatomical structures and their relationships were observed from superficial to deep.
Results:
The transverse fascia lata(TFL) perforating vessel is located 40.62 ± 1.16 mm distal and 41.14 ± 1.26 mm posterior to the anterior superior iliac spine (ASIS). The fascia lata is incised 19.44 ± 0.49 mm medial to this vessel to access the Hueter interval. Within this interval, the ascending branch of the lateral femoral circumflex artery (a-LFCA) is 31.17 ± 0.25 mm distal to the perforating vessel. The lateral femoral cutaneous nerve branches cross the interval at 48.02 ± 0.38 mm from the ASIS, and its main trunk is 2.64 ± 0.11 mm thick, 39.33 ± 0.43 mm from the incision projection, 21.98 ± 1.05 mm from the Hueter interval. The femoral nerve is closest to the acetabulum at 90°, 17.55 ± 0.44 mm from the anterior margin, and the uppermost branch entering the rectus femoris is 8.62 ± 0.08 mm from the ASIS. Releasing the joint capsule and external rotator muscle group increases femoral lift by 19.12 ± 0.20 mm.
Conclusion:
The TFL perforating vessel can be located through the ASIS, and further, the Hueter interval and the a-LFCA can be located through the vessel. Attention should be paid to the corresponding safe and dangerous areas during operation to reduce complications. These findings allow precise surgical entry to minimize risks and shorten learning curve.
