The Minimally Invasive Anterolateral Approach in Supine Position for Primary Total Hip Arthroplasty: Surgical Technique and a Narrative Review of Clinical Outcomes

Abstract

The anterolateral approach has been widely adopted in total hip arthroplasty (THA), with numerous modifications described since its original introduction. Among these, the minimally invasive anterolateral (MIS-AL) approach, also referred to as the anterior-based muscle-sparing approach, has been developed to minimize soft-tissue damage by preserving the integrity of the gluteus medius muscle. This narrative review describes the surgical technique of the MIS-AL approach for primary THA performed in the supine position and provides a summary of clinical outcomes. When performed in the supine position, the MIS-AL approach offers several advantages beyond its muscle-sparing nature. It does not require a specialized operating table, allows for a simplified operating room setup, facilitates the use of intraoperative fluoroscopy, and enables simultaneous bilateral THA without the need for re-draping. In addition, available evidence suggests that this approach is associated with faster postoperative recovery and a reduced risk of postoperative dislocation, supporting the MIS-AL approach as a reliable and muscle-sparing option for primary THA.