Abstract
ObjectiveOne-stage bilateral, muscle-preserving, calcar-guided implantation technique through the modified minimally invasive anterolateral approach in supine position.IndicationsBilateral primary/secondary osteoarthritis of the hip; bilateral femoral head necrosis; ASA I–III.ContraindicationsASA IV; severe osteoporosis, other factors jeopardizing stable anchorage of cementless, calcar-guided short-stem; infection.Surgical techniqueSupine position. Skin incision. Opening of fascia; blunt dissection, pushing gluteal muscles dorsally with the index finger. Capsulectomy. Individual osteotomy according to preoperative plan to determine short-stem position. Remove femoral head. Prepare acetabulum. Position cup. Femoral preparation with the curved opening awl. Spare greater trochanter and gluteal muscles. Insert trial rasps in ascending sizes with “round-the-corner” technique. Select offset version, then trial reposition with intraoperative radiograph and implantation of the definitive implant. Wound closure. Consultation with the anesthesiologist to confirm a stable patient. Same procedure on contralateral hip.Postoperative managementMobilization on day 1 with immediate full weight bearing. Remove wound drains and urinary catheter (only female patients) on day 2. Intensive protocol of physiotherapy and rehabilitation. Thrombosis prophylaxis. Rehabilitation from day 7.ResultsAlmost 500 patients have undergone surgery since 2010. First consecutive 54 patients (108 hips) prospectively evaluated. After 2 years, Harris Hip Score was 98.8; satisfaction on visual analogue scale was 9.9. Low peri- and postoperative complication rates; no implant revisions.ConclusionThe muscle-sparing approach and the special “round-the-corner” technique in one-stage bilateral procedure leads to rapid mobilization and rehabilitation with excellent early clinical results and high satisfaction rates.
Highlights
A recent analysis of the Swedish hip arthroplasty registry revealed that 17% of all patients receiving primary total hip arthroplasty (THA) suffer from bilateral symptoms of osteoarthritis [6]
We describe the one-stage bilateral procedure of the muscle-preserving, calcar-guided implantation technique using a calcar-guided short-stem through the modified minimally invasive approaches (MIS) anterolateral approach in supine position
The main goals in modern THA especially in one-stage bilateral procedures today are the sparing of bone and soft tissue, a fast and reliable technique and excellent early clinical results with possible high postoperative activity levels
Summary
A recent analysis of the Swedish hip arthroplasty registry revealed that 17% of all patients receiving primary total hip arthroplasty (THA) suffer from bilateral symptoms of osteoarthritis [6]. In order to ensure a safe procedure and high quality of postoperative function, one-stage bilateral THA needs to provide certain characteristics like short surgery duration, low blood loss and distinct muscle-sparing technique [14]. The development of new calcar-guided, metaphyseal anchoring short-stems amongst others pursues the strategy of being able to spare muscles, soft-tissue and bone [2] They provide characteristics, making these implants well suitable for the usage in MIS techniques [15]. We describe the one-stage bilateral procedure of the muscle-preserving, calcar-guided implantation technique using a calcar-guided short-stem through the modified MIS anterolateral approach in supine position. The main goals in modern THA especially in one-stage bilateral procedures today are the sparing of bone and soft tissue, a fast and reliable technique and excellent early clinical results with possible high postoperative activity levels. The special “round-the-corner” technique of implantation without damage to the greater trochanter and the gluteal muscles is key
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