Prospective and comparative study of the anterolateral mini-invasive approach versus minimally invasive posterior approach for primary total hip replacement. Early results.
ABSTRACT The interest in minimally invasive approaches for total hip replacement (THR) has not waned in any way. We carried out a prospective and comparative study in order to analyse the interest of the anterolateral minimal invasive (ALMI) approach in comparison with a minimally invasive posterior (MIP) approach. A group of 35 primary THRs with a large head using the ALMI approach was compared with a group of 43 THR performed through a MIP approach. The groups were not significantly different with respect to age, sex, bony mass index, ASA score, Charnley class, diagnoses and preoperative Womac index and PMA score. The preoperative Harris Hip Score was significantly lower in the ALMI group. The duration of surgical procedure was longer and the calculated blood loss more substantial in the ALMI group. The perioperative complications were significantly more frequent in this group, with four greater trochanter fractures, three false routes, one calcar fracture, and two metal back bascules versus one femoral fracture in MIP group. Other postoperative data (implant positioning, morphine consumption, length of hospital stay, type of discharge) are comparable, such as the early functional results. No other complication has been noted during the first 6 months. The ALMI approach uses the intermuscular interval between the tensor fascia lata and the gluteus medius. It leaves intact the abductor muscles, the posterior capsule and the short external rotators. The early clinical results are excellent, despite the initial complications related to the initial learning curve for this approach and the use of a large head. The stability and the absence of muscular damage should permit acceleration of the postoperative rehabilitation in parallel with less perioperative complications after the initial learning curve.
The Journal of Bone and Joint Surgery 02/2003; 85-A Suppl 4:39-48. · 3.27 Impact Factor
The Journal of Bone and Joint Surgery 02/2003; 85-A Suppl 4:33-8. · 3.27 Impact Factor
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ABSTRACT: Mini-incision total hip replacement seeks to eliminate some complications of traditional extensile exposure and also attempts to facilitate more rapid rehabilitation of patients after surgery. Different surgical approaches historically have been used to do hip replacement surgery. Anterior or anterolateral approaches have often been selected to decrease the risk of posterior dislocation. Traditional anterolateral approaches have divided the anterior portion of the gluteus medius and minimus and potentially jeopardized the superior gluteal nerve. These disadvantages have been associated with abductor weakness, prolonged limp and decreased patient satisfaction. To overcome these problems, a mini-incision approach was developed using the intermuscular plane between the gluteus medius and the tensor fascia lata. This intermuscular interval through a small incision provides good exposure for total hip replacement and preserves muscle integrity so that rehabilitation can be rapid and the posterior capsule remains intact so that posterior dislocation is less of an issue. The surgical technique for this new innovative approach is described in this article.Clinical Orthopaedics and Related Research 01/2005; · 2.53 Impact Factor