MAASH Technique for Total Hip Arthroplasty: A Capsular Work

Felipe G. Delgado MD
Orthopedic and Trauma Department of the Hospital de Sant Celoni, Barcelona, Spain
Group of Orthopedic Surgery and Sports Medicine, Sant Celoni, Spain

Albert Broch MD
Orthopedic and Trauma Department of the Hospital de Sant Celoni, Barcelona, Spain
Group of Orthopedic Surgery and Sports Medicine, Sant Celoni, Spain

Francisco Reina MD, PhD
Medical Sciences Department, NEOMA Group Research, University of Girona, Spain

Lluís Ximeno MD, PhD
Orthopedic and Trauma Department of the Hospital de Sant Celoni, Barcelona, Spain

David Torras MD
Orthopedic and Trauma Department of the Hospital de Sant Celoni, Barcelona, Spain

Francesc García MD
Orthopedic and Trauma Department of the Hospital de Sant Celoni, Barcelona, Spain

Antoni Salvador MD
Orthopedic and Trauma Department of the Hospital de Sant Celoni, Barcelona, Spain
Group of Orthopedic Surgery and Sports Medicine, Sant Celoni, Spain


Abstract

Background
Dislocation and leg length discrepancy are major complications following total hip arthroplasty (THA). Many surgical approaches for THA have been described, but none suggest a capsular incision that assures good exposure while maintaining adequate capsule integrity in closure.

Purposes
Modified anterolateral approach for stable hip (MAASH) is a modification of the classical Hardinge approach, but specifically preserves the anterior iliofemoral lateral ligament and pubofemoral ligament excising the “weak area” of the capsule, in the so called “internervous safe zone” and introducing the “box concept” for the anterior approach to the hip. This is the main difference of the MAASH approach. This technique can be used as a standard for all THA standard models, but we introduce new devices to make it easier.

Methods
From November 2007 to May 2012, data were collected for this observational retrospective consecutive case study. We report the results of 100 THA cases corresponding to the development curve of this new concept in THA technique.

Results
MAASH technique offers to hip surgeons, a reliable and reproducible THA anterolateral technique assuring accurate reconstruction of leg length and a low rate of dislocation. Only one dislocation and six major complications are reported, but most of them occurred at the early stages of technique development.

Conclusion
MAASH technique proposes a novel concept on working with the anterior capsule of the hip for the anterolateral approach in total hip arthroplasty, as well as for hemiarthroplasty in the elderly population with high dislocation risk factors. MAASH offers maximal stability and the ability to restore leg length accurately.

This Online First Article was published June 2013.
View the full article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.

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