Anterolateral Minimally Invasive Total Hip Arthroplasty (original) (raw)
Related papers
Archives of Orthopaedic and Trauma Surgery, 2006
Introduction: Minimally invasive surgery represents one of the most recent techniques to have emerged within THA. In conventional THA, the incision typically measures 15-20 cm. Minimal invasive approach defined as less invasive to the skin, muscles, or bone may reduce complications and improve recovery time. A number of different approaches and methods have been described in literature. Purpose: This is a prospective study describing the technique and early results of the modified antero-lateral minimal invasive (ALMI) approach and comparing our results to the results of other investigators interested in minimal invasive THA. Materials and methods: Seventy-five consecutive primary total hip arthroplasties (cemented and cementless) were done through a modified ALMI approach (6-8 cm), in which we kept the hip abductors intact. Neither special instruments nor specially designed prostheses were needed. Minimum follow-up was 12 months. Results: The mean Harris hip score for patients after 12-month follow-up was 90 while the mean Merle d'Abugine mean score was 16.5. Both scores reached almost the maximum values within 3 months after surgery. The cup abduction angle for 70% patients was between 35°and 45°. No femoral stem mal-alignment was recorded. The mean operative time of cemented prosthesis was 65 min while that of the cementless prosthesis was 55 min. No wound complications or dislocations were recorded. All the patients were allowed to weight bear in the second post-operative day and involved in an early rehabilitation program. Conclusion: ALMI hip approach with sparing of hip abductors is safe and gives excellent orientation for positioning of prosthesis components. It also allows early and smooth post-operative rehabilitation with fast recovery of the patient in terms of weight bearing.
Journal of Arthroplasty, 2008
Purported advantages of total hip arthroplasty performed with minimally invasive surgical (MIS) approaches are less muscle damage and faster recovery. There are little data scientifically evaluating these claims. Twenty-four consecutive hips were randomized to total hip arthroplasty through 1 of 3 MIS approaches (2-incision, mini-posterior, and mini-anterolateral). Each patient underwent preoperative and postoperative gait analysis. Gait parameters included vertical ground reaction force, velocity, single-leg stance time, limb-loading rate, and abductor torque. All 3 groups demonstrated overall improvements in gait parameters at 6 weeks postoperatively. The anterolateral approach patients showed a decrease in the vertical ground reaction force at mid-stance, whereas the 2-incision and posterior approaches demonstrated no significant change. These results fail to demonstrate any significant advantage of the 2-incision approach over the posterior approach in kinetic gait parameters. Furthermore, the anterolateral approach demonstrates a gait pattern consistent with abductor muscle injury in the early recovery period, despite the MIS approach. Key words: minimally invasive, hip arthroplasty, hip replacement, gait analysis, surgical approach.
Clinical Orthopaedics and Related Research®, 2011
Background For total hip arthroplasty (THA), minimally invasive surgery (MIS) uses a smaller incision and less muscle dissection than the classic approach (CLASS), and may lead to faster rehabilitation. Questions/purposes Does minimally invasive hip arthroplasty result in superior clinical outcomes? Patients and Methods In this double-blind randomized controlled trial, 120 consecutive primary noncemented THAs in 120 patients were assigned to one of two groups (MIS or CLASS). The randomization sequence was stratified for two groups of surgeons, ie, those using a posterolateral approach (PL-CLASS or PL-MIS) and those using an anterolateral approach (AL-CLASS or AL-MIS). Length of the incisions was 18 cm for the CLASS procedures. MIS incisions were extended at the skin level to 18 cm at the end of the procedure. The primary end point was the Harris hip score (HHS) at 6 weeks postoperatively. Patient-centered questionnaires were obtained preoperatively and after 6 weeks and 1 year. Results For the patients in the MIS group (average 7.8 cm incision length), statistically significant increased mean HHSs were seen compared with the CLASS group at 6 weeks and 1 year. This difference was small and mainly caused by the favorable results of the PL-MIS. In the MIS group, surgical time was longer. A learning curve was observed based on operation time and complication rate. Although not statistically significant, the perioperative complication rate was rather high in the (anterolateral) MIS group. Conclusions The minimal invasive approach in THA did not show a clinically relevant superior outcome in the first postoperative year. Level of Evidence Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
The Science of Minimally Invasive Total Hip Arthroplasty
Clinical Orthopaedics and Related Research, 2007
Minimally invasive hip surgery has stimulated a new process in hip arthroplasty. There is consensus among surgeons about the benefits of anesthesia, pain management, and rapid recovery protocols. The benefits of the surgical technique for small incision surgery remain controversial. Some patients influence this controversy because they prefer minimally invasive hip surgery: they associate less body violation and better cosmesis with smaller incisions. Small incision surgery is associated with a learning curve and requires specialized instruments for favorable outcomes. Despite being a more difficult operation to perform, in skilled hands it is a safe procedure that does not increase complication rates as shown by recent prospective, randomized studies. Correct component positioning has been achieved consistently with these procedures and short-term results of small incision surgery are the same as with long incisions. New anesthesia and pain management techniques have led to remarkable early functional results, making same-day surgery possible. With improved instrumentation such as computer navigation, minimally invasive total hip arthroplasty will become more prevalent. Level of Evidence: Level V, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. From the Arthritis Institute, Inglewood, CA. Each author certifies that he has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
BMC Musculoskeletal Disorders
Background: The presented prospective randomized controlled single-centre study compares the clinical outcome up to 12 months after total hip arthroplasty using a minimally invasive single-incision direct anterior (DAA) and a direct transgluteal lateral approach. Methods: A total of 123 arthroplasties were evaluated utilizing the Harris Hip Score (HHS), the extra short musculoskeletal functional assessment questionnaire (XSFMA), the Short Form 36 (SF-36) health survey, a Stepwatch™ Activity Monitor (SAM), and a timed 25 m foot walk (T25-FW). Postoperative x-ray images after THA were reviewed to determine inclination and stem positioning. Results: At final follow-up, the XSFMA functional index scores were 10.3 (anterior) and 15.08 (lateral) while the bother index summed up to a score of 15.8 (anterior) and 21.66 (lateral) respectively, thus only differing significantly for the functional index (p = 0.040 and p = 0.056). The SF-36 physical component score (PCS) was 47.49 (anterior) and 42.91 (lateral) while the mental component score (MCS) summed up to 55.0 (anterior) and 56.23 (lateral) with a significant difference evident for the PCS (p = 0.017; p = 0.714). Patients undergoing THA through a DAA undertook a mean of 6402 cycles per day while those who had undergone THA through a transgluteal approach undertook a mean of 5340 cycles per day (p = 0.012). Furthermore, the obtained outcome for the T25-FW with 18.4 s (anterior) and 19.75 s (lateral) and the maximum walking distance (5932 m and 5125 m) differed significantly (p = 0.046 and p = 0.045). The average HHS showed no significant difference equaling 92.4 points in the anterior group and 91.43 in the lateral group (p = 0.477). The radiographic analysis revealed an average cup inclination of 38.6°(anterior) and 40. 28°(lateral) without signs of migration. Conclusion: In summary, our outcomes show that after 1 year THA through the direct anterior approach results in a higher patient activity compared to THA utilizing a transgluteal lateral approach while no differences regarding hip function are evident. Trial registration: DRKS00014808 (German Clinical Trial Register DRKS); date of registration: 31.05.2018.
Annals of translational medicine, 2017
Multiple approaches to the hip joint have been developed utilizing various intervals and/or intermuscular planes when performing a total hip arthroplasty (THA), each proposing certain advantages. Of these, the Röttinger approach (modified anterolateral or Watson-Jones) is potentially muscle-sparing. Multiple studies have demonstrated favorable outcomes with this approach. However, others showed more complications with a slow learning curve. Due to the paucity of evidence we conducted this study to: (I) present our operative experience and technique of the Röttinger approach; (II) compare short-term complications and operative room (OR) times of this approach to the direct lateral; and (III) review the available literature. This was a review of a longitudinally maintained single-surgeon database of patients who underwent primary THA using either the Röttinger or direct lateral approach. A total of 100 consecutive patients (100 hips) who underwent primary unilateral THA using the Rött...
2017
Total hip arthroplasty remains the treatment of choice for the symptomatic osteoarthritis of the hip. The most common approach used is the Posterior Approach of Moore (PA), known to give good and reliable results [1,2]. Nevertheless, during the last decades the minimal invasive approaches have become more and more popular, especially the Direct Anterior Approach (DAA) by Hueter [3]. This is mainly due to studies showing the advantage of faster recovery (in the first 6 to 12 weeks) and shorter length of stay in hospital but no advantage is seen in long term results [4-8]. However, it’s a technically demanding approach particularly during the early stage of the learning curve [9,10] with occurrence of more intra-operative fractures, nervous lesions and implant malpositioning [11-13]. Beside these two frequently used approaches, the mini-invasive anterolateral approach described by Rottinger (ALA) shows good functional and radiological results [14,15].
MOJ Orthopedics & Rheumatology
One of best MIS hip approaches is at least theoretically the Röttinger's muscles sparing Watson-Jones anterolateral approach in decubitus lateralis but in our hands difficulties were present, especially during leaning curve, to mobilize the femur without excessive supero-medial capsule and external rotators e.g. piriformis and/or obturator internus release. External rotators release increases hip laxity and longer arthroplasty necks are usually used resulting to leg lengthening. In this new approach only the gluteus minimus insertion tendon is temporary elevated. The operating leg is not placed in extension but in 20° flexion, to avoid stress on abductors, as also in adduction and external rotation. The opposite leg is stabilized at the posterior leg support and not the anterior that is removed. The opposite leg on its support in slight abduction and extension and 15° to 20° anterior inclination of the table facilitates even more the femoral access in difficult cases without difficulties.
The Journal of Arthroplasty, 2009
Studies comparing the minimally invasive surgery with 2-incision technique (MIS-2) technique with the conventional transgluteal technique are lacking in the literatures. We compared the clinical outcomes in a series of 166 hips, including 83 MIS-2 total hip arthroplsty (THA) (group I) and another 83 matched-pair series (group II) using conventional transgluteal approach. Demographic data, hospital course, radiographic data, and functional outcome (Western Ontario and McMaster University Osteoarthritis Index and Harris hip score [HHS]) were investigated. The 2 groups significantly differed in 3 and 6-month HHS with a higher HHS in MIS-2 group. But the MIS-2 group had longer operation time, increased blood loss, and more complications. The current study indicates that the benefit of MIS-2 technique was only short-term with quicker functional recovery and shorter duration use of nonsteroid antiinflammatory drugs postoperatively.