The Wuerzburg procedure: the tensor fasciae latae perforator is a reliable anatomical landmark to clearly identify the Hueter interval when using the minimally-invasive direct anterior approach to the hip joint
© Rudert et al. 2016
Received: 16 September 2015
Accepted: 27 January 2016
Published: 3 February 2016
The key for successful delivery in minimally-invasive hip replacement lies in the exact knowledge about the surgical anatomy. The minimally-invasive direct anterior approach to the hip joint makes it necessary to clearly identify the tensor fasciae latae muscle in order to enter the Hueter interval without damaging the lateral femoral cutaneous nerve. However, due to the inherently restricted overview in minimally-invasive surgery, this can be difficult even for experienced surgeons.
Methods and Surgical Technique
In this technical note, we demonstrate for the first time how to use the tensor fasciae latae perforator as anatomical landmark to reliably identify the tensor fasciae latae muscle in orthopaedic surgery. Such perforators are used for flaps in plastic surgery as they are constant and can be found at the lateral third of the tensor fasciae latae muscle in a direct line from the anterior superior iliac spine.
As demonstrated in this article, a simple knowledge transfer between surgical disciplines can minimize the complication rate associated with minimally-invasive hip replacement.
KeywordsDirect anterior approach Hueter interval Minimally-invasive Hip replacement Perforator Anatomical landmark
In the presented technical note, we advocate the use of a constant anatomical structure to clearly identify the Hueter interval and to minimize the risk for iatrogenic nerve injury. As demonstrated, a simple transfer of knowledge between surgical disciplines can significantly advance surgical techniques and eventually improve patient outcomes. The tensor fasciae latae muscle perforator that is routinely used in plastic surgery to lift tensor fasciae latae perforator flaps can serve as a reliable anatomical landmark when using the minimally-invasive direct anterior approach for total hip arthroplasty.
No approval of the ethics committee of the University of Wuerzburg was necessary for the description of the surgical technique outlined in this article. Written informed consent was obtained from patients whose pictures have been used for this article. This publication was funded by the German Research Foundation (DFG) in the funding program Open Access Publishing of the University of Würzburg.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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