Total hip replacement through a minimally invasive, anterolateral approach with the patient supine

Andreas Roth, Rudolf A Venbrocks
Operative Orthopädie und Traumatologie 2007, 19 (5-6): 442-57

OBJECTIVE: Early postoperative mobilization and restoration of pain-free joint function by implantation of a total hip replacement through a standardized, minimally invasive approach regardless of the type of implant with the patient in the supine position.

INDICATIONS: Primary and secondary coxarthrosis. Femoral head necrosis.

CONTRAINDICATIONS: Previously operated patients with deformities of the coxal end of the femur and extensive scarring.

SURGICAL TECHNIQUE: Supine position. Skin incision anterior to the greater trochanter at the level of the interval between the tensor fasciae latae muscle and the iliotibial tract parallel to the acetabulum ascending slightly from distal to proximal. Incision of the iliotibial tract posterior to the interval. Coagulation of intersecting vessels. Blunt dissection to the femoral neck anterior to the gluteal muscles. L-shaped incision of the anterior capsule with the base at the lateral femoral neck. Femoral neck osteotomy and resection of the femoral head. Mobilization of the posterior capsule by incision at the junction with the femur. Insertion of Hohmann elevators to protect the tissue, dissection of the acetabulum and implantation of the acetabular component. In adduction, external rotation and hyperextension, dissection of the coxal end of the femur, and implantation of the prosthetic stem. After reduction, adaptive suture of the cranial capsular parts. Insertion of intraarticular Redon drains. Interrupted suture of the iliotibial tract. Subcutaneous Redon drains. Subcutaneous suture. Skin suture. Sterile dressing. Final radiologic evaluation in anteroposterior view.

POSTOPERATIVE MANAGEMENT: Mobilization from postoperative day 1. Increased loading on the operated leg depending on local pain. Four-point gait from day 2-3. Stair-climbing from day 4.

RESULTS: From September 2004 to July 2006, 195 patients were operated on (105 women, 90 men, average age 64.4 years [37.1-88.4 years]). Average operating time 63 min (35-105 min). Average intraoperative blood loss 437 ml (20-800 ml). Postoperative follow-up of all patients at 3, 6, and 12 months, and then annually. Early restoration of full weight-bearing ability and range of motion within the first few weeks.

COMPLICATIONS: two postoperative periprosthetic fractures. No periarticular ossifications > Brooker II. No hematoma requiring revision. No neurologic deficits.

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