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Primary Total Hip Arthroplasty: Anterolateral and Direct Lateral Approaches
The two transgluteal approaches—anterolateral and direct lateral—may be used for a variety of hip reconstructive procedures. The common features of these approaches include direct splitting of the gluteus medius and minimus musculature proximally; anterior capsulotomy; and preservation of the posterior soft-tissue sleeve, including the posterior capsule and the external rotator musculature. The essential difference between a direct lateral and an anterolateral approach is the handling of the soft-tissues at the distal extent of the muscle split. In the direct lateral approach, the vastus lateralis is elevated in continuity with the gluteal flap, and in the anterolateral approach the vastus lateralis is not elevated.