Minimally Invasive Anterolateral Access Route for Total Hip Arthroplasty

Abstract

Objective: The aim of this study was to present a minimally invasive anterolateral access route and to ascertain whether this enables total hip replacement without compromising the quality of the implant positioning, while maintaining the integrity of the gluteus muscles. Method: A retrospective study was conducted on 260 patients (186 females and 74 males) with an average age of 62 years. There were 18 bilateral cases, totaling 278 hips. All the patients had osteoarthritis and had undergone non-cemented total hip arthroplasty (metal-metal or metal-polyethylene) between October 2004 and December 2007. A minimally invasive anterolateral access route was used, measuring 7 to 10 cm in length, according to body weight and the size of the femoral head. The patients were assessed clinically regarding age, sex and presence of the Trendelenburg sign, and radiologically regarding acetabular and femoral positioning. Results: The acetabular inclination was between 30° and 40° in 78 patients, between 41° and 50° in 189 patients, and 51° or over in 11 patients. On anteroposterior radiographs to study femoral positioning, the positioning was central in 209 cases, 41 presented valgus deviation and 28 presented varus deviation. On lateral views, 173 were central, 67 anterior and 38 posterior. The mean duration of the procedure was 63 minutes. Regarding complications, there were five cases of infection, three of deep vein thrombosis, two of hip dislocation, 80 of lengthening of the lower limbs and five of shortening of the operated limb. The Trendelenburg sign was present in four cases, of which one showed superior gluteal nerve injury. Conclusion: The minimally invasive anterolateral access route made it possible to perform total hip arthroplasty without compromising the positioning of the implants, thereby maintaining the integrity of the gluteus muscles.