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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
UPDATES ON HIP ARTHROPLASTY 102nd CONGRESS OF THE PIEMONTESE-LIGURIAN-LOMBARD SOCIETY OF ORTHOPEDICS AND TRAUMATOLOGY (S.P.L.L.O.T.) - Brescia September 9-10, 2005
NEW TECHNOLOGIES, MODERN INSTRUMENTARIUM IN ARTHROPLASTIC SURGERY
Minerva Ortopedica e Traumatologica 2005 August;56(4):157-63
Minimally invasive hip replacement via anterolateral approach and use of straight stems
Bombelli M., Mayr M., Tschauner C.
Unità di Ortopedia e Traumatologia Ospedale Centrale di Bolzano, Bolzano
The minimally invasive anterolateral hip approach to the hip with patients placed in the contralateral decubitus position has proven an optimal surgical approach for hip replacement. The minimal sacrifice of myotendon insertions is the main feature of this access, thus justifying the term “minimally invasive”. The use of an off-set instrument for actebular preparation and cotyloid im-plantation is mandatory, as are patient positioning and management of the leg during the operation. The key to success is the unusual positioning of the femur in external rotation, adduction and extension which permits access to the femoral canal without violating gluteus medius muscle even when straight stems are used. The learning curve is influenced by certain aspects differing from other minimally invasive procedures; this demands that the surgeon be willing to substantially modify his or her customary practice in order to avoid the pitfalls this approach may pose. This surgical technique reduces postoperative pain and promotes major features of early functional recovery (e.g. the ability to change complex positions soon after the operation), thus enhancing recovery of patient ‘sautonomy.