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As the name implies, this method
provides access to the hip joint without
violating any muscles or tendons. Rather
than cutting muscles, the surgeon works
through muscle planes without detaching
them from the femur (fig 11).
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The external rotator muscles are left intact and attached,
lowering the risk of dislocation. Furthermore, because the
gluteus medius muscle is also not violated, the risk of a
lurching limp is also greatly lowered. By sparing all of the
hipís muscles and tendons, the patient can expect an
enhanced recovery rate and a quicker return to their normal
The lateral and posterior approaches require the patient to
be lying on his or her side (fig. 12). In this position, the
pelvis tends to be tilted and/or rotated to some extent. It is
therefore harder to determine whether the patientís leg
length has been accurately restored, or if the components
were implanted in the optimal position. Use of intraoperative
xray is also cumbersome in this lateral position and is usually
With an anterior muscle-sparing approach, the patient is
positioned lying down face up (fig. 13). In this position, the
pelvis can be positioned without rotation or tilt.
It is more practical to use intraoperative xray (fig. 14) to
help determine and assure that component position is
optimal and that the leg length and hip anatomy is
restored as accurately as possible.