Rubin_The Direct Anterior Approach to Hip Reconstruction, 2e

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CHAPTER 2 A Definitive History of the Direct Anterior Approach

for femoral neck fracture that involved an acrylic prosthe sis. 36 They explained their choice of the anterior approach as follows: To obtain good movement later we believe that it is essential to avoid all damage to muscle and bone. We therefore use Hueter’s vertical incision, which extends about 15 centimeters down from the anterior-superior iliac spine, passes between tensor fasciae latae and sartorius, then lateral to rectus femoris and down to the capsule. 37 —Drs. Judet (1950) Although these early forms of arthroplasty provided pain relief and improved function in the short term, the asso ciated frictional properties of the acrylic implants limited their longevity. 3 This was an attempt to improve the his toric “interpositional arthroplasty,” which had previously involved the pig bladder. The low-friction properties of the acetabular implant from Charnley’s hip arthroplasty played a major role in improving the longevity of these implants. In 1985, Jean Judet described the anterior approach for THA using the Judet table. The Judet table, designed by Jean’s father Henri in 1940, was an indirect traction table. 5 The traction from this table facilitated surgical acetabular fracture reduction and allowed for hip and knee flexion to relieve tension from the sciatic nerve. 38,39 Provided one works on an orthopedic operating table, the maneuvers required to dislocate the joint and expose the femoral head and neck, then the cotyloid cav ity, are simple. Closure is easy, and because the trochanter has not been sectioned, early rehabilitation is possible. 5 Thierry Judet, the son of Robert Judet, is currently working as an orthopedic adult reconstructive surgeon in France. He continues to use the anterior approach for THA. As chief of orthopedics at the Raymond Poincare University Hospital, he has performed more than 2000 THA cases. 36 Joel M. Matta Dr. Joel M. Matta, an orthopedic surgeon who trained at Oregon Health and Science University School of Medicine and the University of Southern California Medical Center, specializes in hip preservation, replacement, and frac tures. 40 He traveled to Paris in 1981 to learn acetabular and pelvic fracture surgery from Emile Letournel (1927 1994), who had studied under Robert Judet. 7 In Paris, he learned to use the Judet table to perform anterior hip arthroplasty. He returned to the United States, continu ing to use the posterior approach for THA. Fifteen years later in 1996, he was approached by a patient who had an anterior THA performed on the Judet table by Letournel. This patient was enthusiastic about the anterior approach. He searched for a surgeon in the United States who had been trained by Letournel and could perform the same operation on his contralateral hip.

I explained to the patient that though I normally did posterior approach, I did have one of the few Judet tables in the U.S., knew the anterior approach, and if he agreed he would be my first hip replacement from anterior. 7 —Dr. Matta (2017) Dr. Matta visited Keggi in Waterbury in the fall of 2001 and then later popularized performing THA via the anterior approach using Judet’s fracture table. His goal was to enable the use of fluoroscopy during the procedure to verify com ponent placement and reduce the high dislocation rate that was commonly observed after posterior THA in that era. But as I got into it, I started to notice that people were recovering more quickly and not feeling as much pain. This was something that I really didn’t expect but it clearly became one of the benefits of the anterior approach, as well as almost eliminating dislocations. What has really driven the move for many doctors to the anterior approach is the will of the patients. 7 —Dr. Matta (2017) By 1996, the Judet tables were no longer being produced due to a lack of demand. Therefore, Dr. Matta worked with Mizuho OSI (Union City, CA, USA) to develop the ProFx table, which later evolved into the Hana table. Shortly after production began in 2003, Joel Matta directed a course with 20 surgeons on how to perform anterior approach THA using the new fracture table. 36 Since then, he has taught over 2000 surgeons these techniques after partner ing with DePuy to form the highly successful “Anterior Advantage” surgeon education curriculum. Joel Matta was instrumental in making a fracture table commercially available and taught its use specifically for anterior approach THA. By standardizing the steps of acetabular and femoral exposure, preparation, and

FIGURE 2.5 Intraoperative photograph of a THA performed on Matta’s fracture table, guided by fluoroscopy. (Reprinted from Hospital expects Godfrey. The Kingston Daily; 1953.) Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2024