MIS hip anterior:general

We offer surgery learning courses for the MIS anterior approach for hip replacement. If you are interested, register


With the term "minimalinvasive anterior approach for hip replacement" is meant an approach with reduced soft tissue lesions during the procedure of hip replacement. Traditional stems but also shorter stems with reduced bone invasion coud be used. The anterior approach was for the first time described by Hueter and got more popular with the name of Smith-Peterson.

  • anterior approach for the implantation of hip prosthesis
  • minimalinvasive approach with protection of muscles and soft tissue
  • fast postoperative recivery and low pain
  • used at Bolzano since 2003 with Arch-table
  • excellent postoperative outcome and results

 

 

 

 

 

 

 

The procedure for the preparation of the acetabulum is quite the same like in other lateral or anterolateral approaches. If you are interested in specific surgery times, let us know this, we will provide.

Femur exposure is often the most difficult part of the surgery. In contracted hips you must know the ways to bring the femur into the correct position for the preparation.

2 passages are important

1. The external rotation of the femur must be 90° (no lesser degrees will be accepted).

2. Exposure of the femur can be achieved by 2 ways:

  • a) release of the proximal femur, so you can "bring out" the femur of the wound
  • b) extension of the leg without release (only in very old contracted hips) - by archtable.

90° external femur rotation (patella looks 90° outside)

the capsule incision must be done on the anterolateral side or - if you have done the incision more anterior - you must complete the capsule incision lateral (like a T). Never start with the femur preparation if the external rotation is less than 90°.

If the femur is very near to the azetabulum you can do a release of the posterior labrum and capsule frome the bony azetabulum (without cutting completeley the capsule): this will give you correct exposure in the most cases when you are using a traction table (like archtable). In severly contracted hips this will improve the exposure of the azetabulum, but is not sufficient for the femur.

First external rotate the femur, then complete the capsule incision on the lateral side, now try to lift up the femur while you are bringing the femur in the perfectly 90° rotated position. If this is not possibile, feel where there is a "string" - often you have not completed the lateral (now posterior sided) capsule. But if you are sure, that the lateral capsule is full opend, then you must incise the capsule lateral-posterior on the cranial side (where you feel the string). often only a small amount is sufficient. With the femur quit 90° external rotated the posterolateral capsule side will be cranially on the inner side of the proximal femur.

If you are operating without the archtable normally you have to cute the piriformis tendon at this moment (often the surgeons believe that they are cutting only the capsule - but the snip with a hearing noise normally means the cutting of the piriformis tendon).

Now you will have sufficient exposure of the femur. Seldom you need a third step: to do the release on the medial side of the femur (external rotators) - only necesary in old contracted hips - and very deep protrusion hips.

Link: video, pictures

Link: MIS hip description

Link. vedi OP-Video

LINK: femural exposure

LINK: archtable

 

LINK: further descrption of the approach