Skip to main content

Advertisement

SpringerLink
Log in

Antero-lateral minimal invasive (ALMI) approach for total hip arthroplasty technique and early results

  • Original Article
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15

Similar content being viewed by others

References

  1. Amadio PC (1993) Editorial. Outcomes measurement: more question; some answers. J Bone Joint Surg 75A:1583–1584

    Google Scholar 

  2. Amstutz HC (1973) Trapezoidal-28 total hip replacement. Clin Orthop 95:158

    PubMed  Google Scholar 

  3. Baker AS, Bitounis VC (1989) Abductor function after total hip arthroplasty: an electromyographical and clinical review. J Bone Joint Surg 71B:47–50

    Google Scholar 

  4. Berger RA (2004) Mini-incision total hip replacement using an anterolateral approach: technique and results. Orthop Clin North Am 35(2):143–151

    Article  PubMed  Google Scholar 

  5. Birnbaum K, Prescher A. Heßler S et al (1997) The sensory innervation of the hip joint: an anatomical study. Surg Radiol Anat 19:371–375

    Article  PubMed  CAS  Google Scholar 

  6. Boettechern WG (1992) Total hip arthroplasties in the elderly: morbidity, mortality, and cost effectiveness. Clin Orthop 274:30–34

    PubMed  Google Scholar 

  7. Bryant MJ, Kernohan WG, Nixon JR, Mallan RAB (1993) A statistical analysis of hip scores. J Bone Joint Surg 75-B:705–709

    Google Scholar 

  8. Chang RW, Pellisier IM, Hazen GB (1996) A cost effectiveness analysis of total hip arthroplasty for osteoarthritis of the hip. JAMA 275:858–865

    Article  PubMed  CAS  Google Scholar 

  9. Charnley J, Ferriera A, De SO (1964) Transplantation of the greater trochanter in arthroplasty of the hip. J Bone Joint Surg 46B:191

    Google Scholar 

  10. Chimento GF, Pavone V, Sharrock NE et al (2003) Minimal invasive total hip arthroplasty: a prospective randomized study: paper presented at 70th annual meeting of American academy of orthopedic surgeons. New Orleans

  11. Christoph Roder C (2003) The Frank Stinchfield Award. Demographic factors affecting long-term outcome of total hip arthroplasty. Clin Orthop 417:62–73

    PubMed  Google Scholar 

  12. Chung WK, Liu D, Foo LS (2004) Mini-incision total hip replacement—surgical technique and early results. J Orthop Surg (Hong Kong) 12(1):19–24

    CAS  Google Scholar 

  13. Cushner F, Friedman RJ (1988) Economic impact of total hip arthroplasty. South Med J 81:1379–1381

    PubMed  CAS  Google Scholar 

  14. Dall D (1986) Exposure of the hip by anterior osteotomy of the greater trochanter: a modified anterolateral approach. J Bone Joint Surg 68B:382

    Google Scholar 

  15. DiGioia AM III, Plakseychuk AY, Levison TJ, Jaramaz B (2003) Mini-incision technique for total hip arthroplasty with navigation. J Arthroplasty 18(2):123–128

    Article  PubMed  Google Scholar 

  16. Dorr LD (2004) The mini-incision hip: building a ship in a bottle. Orthopedics 27(2):192–194

    PubMed  Google Scholar 

  17. Engh CA Jr, McAuley JP, Sychterz CJ, Sacco ME, Engh CA Sr (2000) The accuracy and reproducibility of radiographic assessment of stress-shielding: a postmortem analysis. J Bone Joint Surg 82A:1414–1420

    Google Scholar 

  18. Fackler CD, Poss R (1980) Dislocation in total hip arthroplasties. Clin Orthop 151:169–178

    PubMed  Google Scholar 

  19. Frndak PA, Mallory TH, Lombardi AV (1993) Translateral surgical approach to the hip: the abductor muscle “split”. Clin Orthop 295:135–141

    PubMed  Google Scholar 

  20. Gibson A (1950) Posterior exposure of the hip joint. J Bone Joint Surg 32B:183–191

    Google Scholar 

  21. Goldstein WM, Branson JJ, Berland KA, Gordon AC (2003) Minimal-incision total hip arthroplasty. J Bone Joint Surg Am 85(suppl 4):33–38

    PubMed  Google Scholar 

  22. Gore DR, Murray MP, Sepic SB et al (1982) Anterolateral compared to posterior approach in total hip arthroplasty: differences in component positioning, hip strength, and hip motion. Clin Orthop 165:180–187

    PubMed  Google Scholar 

  23. Hardinge K (1982) The direct lateral approach to the hip. J Bone Joint Surg 64B:17

    Google Scholar 

  24. Hardy AE, Synek V (1988) Hip abductor function after the Hardinge approach: brief report. J Bone Joint Surg 70B:673

    Google Scholar 

  25. Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. J Bone Joint Surg 51A:737–755

    Google Scholar 

  26. He XH, Tay SS, Ling EA (1988) Sensory nerve endings in monkey hip joint capsule: a morphological investigation. Clin Anat 11(2):81–85

    Article  Google Scholar 

  27. Head WC, Mallory TH, Berklacich FM et al (1987) Extensile exposure of the hip for revision arthroplasty. J Arthroplasty 2:265

    Article  PubMed  CAS  Google Scholar 

  28. Hedley AK, Hendren DH, Mead LP (1990) A posterior approach to the hip joint with complete posterior capsular and muscular repair. J Arthroplasty 5(Suppl):57–66

    PubMed  Google Scholar 

  29. Hedlundh U, Ahnfelt L, Hybbinette CH et al (1996) Surgical experience related to dislocation after total hip arthroplasty. J Bone Joint Surg 78B:206–209

    Google Scholar 

  30. Heller MO, Perka C, Wilke K et al (2003) Surgical approach in total hip arthroplasty causes long term differences in periprosthetic femoral bone densities. Trans Orthop Res Soc 49:1349

    Google Scholar 

  31. Horwitz BR, Rockowitz NL, Goll SR et al (1993) A prospective randomized comparison of two surgical approaches to total hip arthroplasty. Clin Orthop 291:154–163

    PubMed  Google Scholar 

  32. Ishii Y, Tojo T, Terajima K, Yamaguchi N, Suzuki R, Kunou Y (1999) Intracapsular components do not change hip proprioreception. J Bone Joint Surg 81B:345–348

    Article  Google Scholar 

  33. Keggi KJ, Keggi JM, Kennon RE (2005) Minimal incision total hip arthroplasty via the anterior approach. Curr Opin Orthop 16(1):10–13

    Article  Google Scholar 

  34. Knahr K, Kryspin-Exener I, Jagsch R, Freilinger W, Kasparek M (1998) Evaluating the quality of life before and after implantation of a total hip endoprosthesis. Z Orthop Ihre Grenzgeb 136:312–319

    Article  Google Scholar 

  35. Lieberman JR, Dorey F, Shekelle P et al (1996) Differences between patients and physician evaluations of outcome after total hip arthroplasty. J Bone Joint Surg 78-A:835–838

    Google Scholar 

  36. Madsen MS, Ritter MA, Morris HH, Meding JB, Berend ME (2004) The effect of total hip arthroplasty surgical approach on gait. J Orthop Res 22(1):44–50

    Article  PubMed  Google Scholar 

  37. Mallory TH, Lombardi AV, Fada RA, Herrington SM, Eberle RW (1999) Dislocation after total hip arthroplasty using the anterolateral abductor split approach. Clin Orthop 358:166–172

    Article  PubMed  Google Scholar 

  38. McCollum DE, Gray WJ (1990) Dislocation after total hip arthroplasty: causes and prevention. Clin Orthop 261:159–170

    PubMed  Google Scholar 

  39. Merle d’Aubigne´ R, Postel M (1954) Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg 36A:451–475

    Google Scholar 

  40. Moore AT (1959) The Moore self-locking Vitallium prosthesis in fresh femoral neck fractures: a new low posterior approach (the southern exposure). AAOS Instr Course Lect 16:309

    Google Scholar 

  41. Müller ME (1970) Total hip prostheses. Clin Orthop 72:46

    PubMed  Google Scholar 

  42. Mulliken BD, Rorabeck CH, Bourne RB et al (1998) A modified direct lateral approach in total hip arthroplasty: a comprehensive review. J Arthroplasty 13:737–747

    Article  PubMed  CAS  Google Scholar 

  43. Nakamura S, Matsuda K, Arai N, Wakimoto N, Matsushita T (2004) Mini-incision posterior approach for total hip arthroplasty. Int Orthop 28(4):214–217

    Article  PubMed  Google Scholar 

  44. Pavone V, Chimento GF, Sharrock N, Sculco T (2001) The role of incision length in total hip arthroplasty. J Bone Joint Surg 83B(Suppl 2):213S

    Google Scholar 

  45. Perka C et al (2005) Surgical approach influences periprosthetic femoral bone density. Clin Orthop 432:153–159

    PubMed  Google Scholar 

  46. Rieker C, Oberholzer S, Wyss U (2001) World tribology forum in arthroplasty. Hans Huber, Bern

    Google Scholar 

  47. Ritter MA, Harty LD, Keating ME, Faris PM, Meding JB (2001) A clinical comparison of the anterolateral and posterolateral approaches to the hip. Clin Orthop 385:95–99

    Article  PubMed  Google Scholar 

  48. Roberts JM, Fu FH, McClain EJ et al (1984) A comparison of the posterolateral and anterolateral approaches to total hip arthroplasty. Clin Orthop 187:205–210

    PubMed  Google Scholar 

  49. Roberts JM, Fu FH, McLain EJ, Ferguson AB (1984) A comparison of the posterolateral and anterolateral approaches to total hip replacement. Clin Orthop 187:205–210

    PubMed  Google Scholar 

  50. Robinson RP, Robinson HJ Jr, Salvati EA (1980) Comparison of the transtrochanteric and posterior approaches for total hip replacement. Clin Orthop 147:143–147

    PubMed  Google Scholar 

  51. Sculco TP, Jordan LC (2004) The mini-incision approach to total hip arthroplasty. Instr Course Lect 53:141–147

    PubMed  Google Scholar 

  52. Sculco TP, Jordan LC, Walter WL (2004) Minimally invasive total hip arthroplasty: the Hospital for Special Surgery experience. Orthop Clin North Am 35(2):137–142

    Article  PubMed  Google Scholar 

  53. Sherry E, Egan M, Henderson A, Warnke PH (2002) Minimally invasive techniques for total hip arthroplasty. J Bone Joint Surg Am 84-A:1481

    PubMed  Google Scholar 

  54. Siguier T, Siguier M, Brumpt B (2004) Mini-incision anterior approach does not increase dislocation rate: a study of 1,037 total hip replacements. Clin Orthop Relat Res 426:164–173

    Article  PubMed  Google Scholar 

  55. Suarez-Suarez MA, Murcia-Mazon A (2004) A simple method to facilitate mini-incision in total hip arthroplasty. J Arthroplasty 19(3):395–396

    Article  PubMed  Google Scholar 

  56. Vicar AJ, Coleman CR (1984) A comparison of the anterolateral, transtrochanteric, and posterior surgical approaches in primary total hip arthroplasty. Clin Orthop 188:152–169

    PubMed  Google Scholar 

  57. Wenz JF, Gurkan I, Jibodh SR (2002) Mini-incision total hip arthroplasty: a comparative assessment of perioperative outcomes. Orthopedics 25(10):1031–1043

    PubMed  Google Scholar 

  58. Woo RY, Morrey BF (1982) Dislocations after total hip arthroplasty. J Bone Joint Surg 64A:1295–1306

    Google Scholar 

  59. Woolson ST, Mow CS, Syquia JF, Lannin JV, Schurman DJ (2004) Comparison of primary total hip replacements performed with a standard incision or a mini-incision. J Bone Joint Surg Am 86-A(7):1353–1358

    PubMed  Google Scholar 

  60. Wright JM, Crockett HC, Delgado S, Lyman S, Madsen M, Sculco TP (2004) Mini-incision for total hip arthroplasty: a prospective, controlled investigation with 5-year follow-up evaluation. J Arthroplasty 19(5):538–545

    Article  PubMed  Google Scholar 

  61. Zati A, Degli Espoosti S, Spagnoletti C, Martucci E, Bilotta TW (1997) Does total hip arthroplasty mean sensorial and proprioceptive lesion? A clinical study. Chir Organi Mov 82(3):239–247

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik Für Orthopädie und Orthopädische Chirurgie, Johanna-Etienne-Krankenhaus, Am Hasenberg 46, 41462, Neuss, Germany

    Jörg Jerosch & Claus Theising

  2. Alexandria University, Alexandria, Egypt

    Mohie Eldin Fadel

Authors
  1. Jörg Jerosch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Claus Theising
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohie Eldin Fadel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jörg Jerosch.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jerosch, J., Theising, C. & Fadel, M.E. Antero-lateral minimal invasive (ALMI) approach for total hip arthroplasty technique and early results. Arch Orthop Trauma Surg 126, 164–173 (2006). https://doi.org/10.1007/s00402-006-0113-x

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-006-0113-x

Keywords

Search

Navigation