Total hip arthroplasty (THA) is one of the most successful and cost-effective interventions in medicine nowadays, providing reliable pain relief and functional improvement to those with osteoarthritis or inflammatory arthritis of the hip (P Kinov, B Antonov,’Possibilities for surgical treatment of acetabular osteolysis subsequent to revision arthroplasty of hip joint‘, Orthop Trauma. 52, 2015). Revision hip arthroplasty or severe reconstructive procedures in cases with significant anatomical defects require skilled surgical staff and accurate preoperative planning, including bone insufficiency, deficiency, discontinuity (anatomical assessment) as well as augmentation, cage or other requirements. (implant planning). Some authors recommend preoperative 3D model planning for precise anatomical assessment and preoperative training. This method has some limitations but could be successfully used in addition to conventional surgery.
The MIS anterolateral approach for hip replacement surgery uses the intermuscular plane between gluteus medius and tensor fascia latae. The patient is placed in the lateral position. Retractors with soft tissue friendly profile and an operating table with modified leg support are recommended. The technique provides very good exposure of the acetabulum and femur and preserves muscle integrity so that rehabilitation can be rapid. Currently the experience comprises over 1000 primary cases performed using the MIS anterolateral approach since March 2003. The clinical results including pain, blood loss, range of motion, functional score, Harris Hip Score, and radiographic studies are based on the complete examinations of 48 consecutive patients. There are significant differences with improved clinical results compared with patients after standard approaches. After a fundamental learning curve there is no evidence of increased complications. The anterolateral approach is a standard approach suitable for wide application. The experience includes difficult primary cases like dysplasia, rheumatic disease, and ankylosis and even for revision surgery the technique can be routinely used. Restrictions are not known either in patients' characteristics or in indications.
Currently, the experience comprises over 3,500 patients operated on using the minimally invasive anterolateral approach since March 2003. Restrictions regarding indications are not known. In experienced hands, the technique can even be used for revision surgery. The clinical results show significant differences with improved clinical results as compared to patients after standard approaches, especially in terms of skin-to-skin time, blood loss, use of analgesics, rehabilitation time, and functional outcome. The accuracy of implant placement is not compromised. After a fundamental learning curve, there is no evidence of increased complications.
The purpose of this study is to describe our early experience in the development and use of a minimally invasive, anterolateral approach to the hip joint for total hip arthroplasty (THA). This approach uses a specific intraoperative protocol involving leg positioning to maximise exposure and hip joint visualisation. Between October, 2004 and December, 2004, we operated on 18 male and 29 female patients without selection and in consecutive order. The average patient age at surgery was 66 years (range 28 to 86 yrs) with an average body mass index (BMI) of 26 (range 18 36) and with a majority of patients presenting with osteoarthritis as the primary indication for surgery. The average length of the skin incision was 8 cm and the average incision-to-suture time was 45 minutes. The preoperative average Harris Hip Score was 38 and improved to 70 at 10 days postoperatively, and 92 at three and six months. Similarly, the HHS average pain component score increased from 12.6 preoperatively to 39 at 10 days postoperatively, and 40 at three and six months. An exact neutral implantation of the stem was found in 48% of the patients, between one to three degrees out of neutral in 40% and greater than four degrees of varus in 12%. The average inclination angle of the cup was measured at 44 degrees. No intraoperative or perioperative complications of any kind occurred in this series of 47 consecutive patients. From our experience, the MIS AL approach for THA with patients in the lateral position can be applied without restrictions for patient indication. Improved results can be observed when using the MIS AL approach, especially in the ear-ly postoperative phase. Since the abductors can be completely spared during the surgery, improved long-term results may be expected. Moreover and when necessary, an operative expansion is always possible without difficulties. Overall, the approach yields promising results.
The purpose of this study is to describe our early experience in the development and use of a minimally invasive, anterolateral approach to the hip joint for total hip arthroplasty (THA). This approach uses a specific intraoperative protocol involving leg positioning to maximise exposure and hip joint visualisation. Between October, 2004 and December, 2004, we operated on 18 male and 29 female patients without selection and in consecutive order. The average patient age at surgery was 66 years (range 28 to 86 yrs) with an average body mass index (BMI) of 26 (range 18 36) and with a majority of patients presenting with osteoarthritis as the primary indication for surgery. The average length of the skin incision was 8 cm and the average incision-to-suture time was 45 minutes. The preoperative average Harris Hip Score was 38 and improved to 70 at 10 days postoperatively, and 92 at three and six months. Similarly, the HHS average pain component score increased from 12.6 preoperatively to 39 at 10 days postoperatively, and 40 at three and six months. An exact neutral implantation of the stem was found in 48% of the patients, between one to three degrees out of neutral in 40% and greater than four degrees of varus in 12%. The average inclination angle of the cup was measured at 44 degrees. No intraoperative or perioperative complications of any kind occurred in this series of 47 consecutive patients. From our experience, the MIS AL approach for THA with patients in the lateral position can be applied without restrictions for patient indication. Improved results can be observed when using the MIS AL approach, especially in the ear-ly postoperative phase. Since the abductors can be completely spared during the surgery, improved long-term results may be expected. Moreover and when necessary, an operative expansion is always possible without difficulties. Overall, the approach yields promising results.
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