Posterior Exposure in Kocher–Langenbeck With Gluteus Minimus Debridement vs. the Gibson Approach: A Cadaveric Study

Objective: To quantify the posterior acetabular exposure achieved with the Kocher–Langenbeck (K–L) with gluteus minimus debridement and Gibson approaches. Methods: A Kocher–Langenbeck approach and a subsequent Gibson approach on the contralateral hip were performed in the prone position on 9 fresh frozen cadavers. Calibrated digital images were obtained of the Kocher–Langenbeck exposure, Kocher–Langenbeck exposure after gluteus minimus debridement, and Gibson exposure. The surface area of the posterior hip and pelvis visualized with each approach was calculated and compared with the contralateral side to assess for the difference between exposures. Results: In 5 of the 9 cadavers, the Kocher–Langenbeck exposure before gluteus minimus debridement yielded an increased exposure in comparison with the Gibson approach, and the exposure was equivocal in 3 specimens. An increase of greater than 10% was considered significant. The exposure increased anteriorly and cranially by an average of 13.1 cm2 after debridement of the gluteus minimus caudal to the superior gluteal neurovascular bundle in the Kocher–Langenbeck approach. Conclusions: Debridement of the gluteus minimus caudal to the level of the superior gluteal neurovascular bundle can significantly increase anterior and cranial exposure in the Kocher–Langenbeck approach and provide similar areas of access when compared with that in the Gibson approach.