How to Avoid Complication in the ABMS Total Hip Replacement

Three major complication types could be commonly related to the anterior-based muscle-sparing (ABMS) surgical approach: nerve injuries, intraoperative periprosthetic fractures, and postoperative dislocations. • Nerve injury is a relatively rare, yet poten- tially devastating, complication: lateral femo- ral cutaneous nerve (LFCN) and femoral nerve (FN) injuries are potentially more com- mon with the ABMS approach compared with other lateral-/posterior-based approaches. • Placing the skin incision at the anterior edge of the greater trochanter and firmly position- ing the retractor at 12 o’clock without apply- ing too much tension on the underlying soft tissue/muscle structures help surgeons avoid these nerve injuries. • The ABMS approach dislocation rate is about the same of DAA (direct anterior approach) and therefore improved compared with posterior-based approaches. • Intraoperative periprosthetic fractures are thought to be more common with the ABMS approach than with posterior-based approaches. • The greater trochanter is the site prone to frac- ture with the use of the ABMS approach: accurate planning of prosthesis design/size along with the proper peri-trochanteric soft tissue releases and patient positioning decrease prevalence of these fractures.