Minimally Invasive Anterolateral Surgical Approach for Total Hip Arthroplasty: Early Clinical Results

Abstract

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.

Impact of Active Ankle Movement Frequency on Velocity of Lower Limb Venous Flow following Total Hip Arthroplasty

“…Surgery was performed using a minimally invasive anterolateral approach without detachment of muscle or tendon with the patient in the lateral decubitus position [7]. All surgeries were performed or supervised by a high-volume hip surgeon (NH).…”

Modified Anterolateral Minimally Invasive Surgery (ALMIS) for Total Hip Replacement: Anatomical Considerations, Range of Motion and Clinical Outcomes

“…The ALMIS technique for THA was introduced in 2004 by Röttinger and in 2017 modified by Christodoulou [ 8 , 9 ]. More specifically, the positioning of the patient was changed, allowing for better visualization during preparation and the anterior ¼ of the GM was elevated, allowing easier access to the hip joint and the acetabulum.…”

“…The anterolateral minimally invasive surgery (ALMIS) for THA was initially described in 2004 by Röttinger and, later on, in 2017, modified by Christodoulou [ 7 , 8 , 9 ]. Röttinger introduced the “anterolateral” minimally invasive technique for total hip replacement, which involved employing the standard Watson-Jones interval.…”

“…Röttinger introduced the “anterolateral” minimally invasive technique for total hip replacement, which involved employing the standard Watson-Jones interval. However, a distinct intermuscular plane between the tensor fasciae latae (TFL) and the gluteus maximus (GM) was created without any muscle or tendon incisions or detachment [ 7 , 8 ]. In the modified ALMIS approach, the anterior ¼ of the GM is retracted and the patient is positioned differently from the initially described technique [ 9 , 10 ].…”

Is the internal rotation lag sign a sensitive test for detecting hip abductor tendon ruptures after total hip arthroplasty?

“…Among the regularly performed approaches to the hip joint are the anterior (Smith-Peterson) [3,4], anterolateral (Watson-Jones) [5,6], lateral transgluteal (Hardinge) [7], and posterior (Moore), [8] approach, virtually each of which has been modified for minimally invasive hip replacement surgery [9-14] and comprises its distinct features, problems and pitfalls [15-17]. In patients with THA implanted by a direct lateral transgluteal approach, weakness of external hip rotation due to iatrogenic damage to the external rotators is possible [18,19].…”