Rubin_The Direct Anterior Approach to Hip Reconstruction, 2e

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SECTION I Introduction

the 1000+-page textbook titled Compendium of Surgery (published in 1881; Figure 2.1 ), which included the earliest known written description of the anterior approach to the hip. 1 Dr. Hueter used this surgical approach to resect the femoral head in cases of septic arthritis. Marius Nygaard Smith-Petersen (1886-1953) In the spring of that year [1916] I assisted in an open reduction of a congenital dislocation of the hip. The hip was exposed through a Kocher incision; it was bloody; it was brutal. The patient survived by a very narrow margin. . . There must be some other way of exposing the hip. 9 Smith-Petersen was born in Grimstad, Norway, in 1886 and emigrated to the United States (Milwaukee, WI) at the age of 16 years. He completed 1 year of under graduate studies at the University of Chicago and then completed the rest of his undergraduate years at the University of Wisconsin (graduated in 1910). He com pleted medical school at Harvard and subsequently enrolled at the Peter Bent Brigham Hospital in Boston

as a general surgery intern under the guidance of neu rosurgeon Harvey Williams Cushing. 9,10 Some of his innovative work involved spinal osteotomy, femoral neck fracture fixation, and mold interposition hip arthroplasty. In 1917, at the age of 31 years, Smith-Petersen wrote the following: The incision just described seems to offer an easy approach to the acetabulum without injury to import ant structures. . . This incision has not as yet been tried out in cases other than congenital hip reductions. It seems not improbable that it may be of value in cases demanding good exposure of the acetabulum – arthrod esis for instance. 2 Smith-Petersen is credited with popularizing the anterior approach to the hip in the United States, first describing it in 1917 for the treatment of congenital hip disloca tion. 2,11 He also used a proximal extension of the inci sion, traveling posteriorly along the iliac wing, which also allowed exposure to the outer table of the ilium. He used this for the treatment of congenital hip dislocation, vital lium mold arthroplasty, and femoroacetabular impinge ment. In a vivid article, he described how he coined the approach. 9 He credits the principles he learned from Dr. Harvey Cushing, including “respect for structures and structural planes.” He described a Kocher approach used for congenital hip dislocation as “bloody and brutal.” He was inspired by the delicate nature of Cushing’s cerebellar exposures. Each structure was reflected intact and “never in shreds.” 9 The day after witness ing a Kocher approach performed for congenital hip dislocation, 31-year-old Smith-Petersen obtained a cadaver and experimented with the anterior approach. He showed the specimen to his chief of orthopedics, Dr. Elliott Gray Brackett, who thought the new approach was promising. Dr. Brackett brought the specimen to the American Orthopaedic Association meeting. Smith Petersen received a letter 1 year later from a surgeon who was now using his approach and stated he would use no other approach. Smith-Petersen most likely developed the approach independently, unaware of Carl Hueter’s description of the interval. 9 Smith-Petersen described how he developed the approach as follows: “I had a new way of exposing the hip joint” and makes no reference to Hueter’s description. 9 He told his senior colleague, Dr. Roy Abbott, “there must be some other way of exposing the hip.” Abbott’s response was, “Why don’t you figure one out?” 9 He treated hip arthritis with the mold arthroplasty. He used his anterior approach to interpose a prosthetic cup between the femoral head and the acetabulum. This was intended to be removed 2 years later with the goal of having created a smoother surface. Early glass mold com ponents shattered within the joint, so he transitioned to newer vitallium alloy implants (having learned about this new material from his dentist), which allowed for perma nent implantation. Using histologic data, he determined

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FIGURE 2.1 Illustration from Hueter’s textbook. (Reprinted from Hueter C. Grundriss der Chirurgie. 2nd ed. FCW Vogel; 1883.)