[Minimally invasive anterolateral approach for total hip replacement (OCM technique)].

OBJECTIVE: Hip replacement with reduction of operative trauma. Thereby earlier mobilization and faster rehabilitation time compared with conventional techniques. No restrictions with regard to exposure of femur and acetabulum.

INDICATIONS: Primary total hip arthroplasty. With experience also applicable in revisions.

CONTRAINDICATIONS: None.

SURGICAL TECHNIQUE: Patient in lateral position with fixed pelvis. Leg support for the leg being operated and modified leg support for the contralateral side on the operating table. Special retractors and instruments are advisable. Skin incision over the anterior portion of the greater trochanter slightly curved then over the muscular interval between gluteus medius and tensor fasciae latae. Fascia incision. Preparation of anterolateral muscular interval. Exposure and incision of capsule. Leg positioning for neck osteotomy in external rotation and hyperextension. For preparation of acetabulum leg again on support. Preparation of acetabulum and cup implantation. For femoral preparation leg in external rotation, hyperextension, and adduction. Capsular release nearby greater trochanter. Capsular release and stem implantation. Repositioning. Capsule and wound closure.

POSTOPERATIVE MANAGEMENT: Early mobilization. Physical therapy and lymph drainage. Loading of the leg according to tolerance; if patient is pain-free, full weight bearing allowed. Thrombosis prophylaxis for at least 3 weeks postoperatively.

RESULTS: 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.