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Online ISSN 1827-1707
CURRENT TRENDS IN MODERN HIP SURGERY TRENDS AND REAL INNOVATIONS IN THE 1° IMPLANT
Marinoni E. C., Trevisan C., Castoldi G., Mattavelli M., Nava V.
Clinica Ortopedica Università degli Studi Milano-Bicocca Ospedale S. Gerardo, Monza, Milano
The lateral approach to the hip, described by Bauer in 1979, successfully employed for the traditional total hip arthroplasty and based on a digastric muscular flap. This approach can have some difficulties, like the unsatisfactory visualization and difficult approach to the acetabulum due to the sparing of femoral head in the resurfacing of the hip. Another potential problem is the capability to achieve the required femur extrarotation necessary to prepare the femoral head. From 24 months, we have started implanting hip resurfacing arthroplasty with modified lateral approach in selected patients. Our approach to the hip is permorfed with a more anterior dissection of the gluteus medius and a more posterior section of the conjoined tendon of gluteus medius and vastus lateralis to obtain a solid tendineous flap. Then, once we reach joint, the section of the capsule is extended to its posterior face to improve extrarotation of the femur. It is important to avoid damaging the superior gluteus nerve. The lateral approach to the hip respects also the medial femoral circumflex artery. With the modified lateral approach to the hip we had a satisfactory surgical exposure and a suitable visualization of the acetabulum. The modified lateral approach to the hip is adequately quick and safe. In our experience, we had only 1 case, out of 15 patients, of temporary paralysis of superior gluteal nerve, that recovered in 6 months without any treatment. None of our patients had an avascular necrosis of femoral haed after the implant. None of our patients had a fracture of the femoral neck.