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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
TISSUE SPARING SURGERY (T.S.S.) TECHNIQUES CURRENT TRENDS IN MODERN HIP SURGERY TRENDS AND REAL INNOVATIONS IN THE 1° IMPLANT
Minerva Ortopedica e Traumatologica 2006 August;57(4):199-20
The minimally invasive anterolateral approach (ocm) in total hip replacement: technical and clinical considerations after 100 cases
Bombelli M., Mayr M., Tschauner C.
Dipartimento di Ortopedia e Traumatologia Ospedale Centrale di Bolzano, Bolzano
The modification of the classical anterolateral Watson Jones approach for total hip replacement according to criterias of tissue sparing surgery as featured with the OCM technique effectively preserves all the musculo-tendinous structures around the hip joint; in particular the insertions and bellies of the gluteal muscles are not violated nor need to be reconstructed providing excellent conditions for early active postoperative reeducation. Overview over the acetabulum is excellent once the femoral head has been resected through a two-step procedure. Acetabular reaming is best achieved using cardanic less invasive reamers. The use of dog tailed cup inserters is mandatory avoiding impingement with surrounding muscles and correctly placing the acetabular component. Femoral exposure in external rotation, adduction and extension of the leg with the patient lying in the contralateral decubitus position is unusual for replacement purposes but is the key of success. An adeguate learning curve must be overcome due to peculiarities that characterize this surgical technique especially in strong male patients. Patients operated via a minimally invasive anterolateral approach experience a substantial and almost painless improvement in active range of joint mobility without any restrictions for sake of joint and pelvic stability (Trendelenburg gait) from the first days on and particularly combined active movements in postural changes such as raising up from bed and chair to the standing position and viceversa are performed with impressive ease even by patients who had been suffering from highly restricted range of motion and mobility for years . No ossifications nor insertion tendinopaties are observed during the following months up to one year after implantation without any perioperative prophylactic medication.