One-stage bilateral implantation of a calcar-guided short-stem in total hip arthroplasty : Minimally invasive modified anterolateral approach in supine position.
OBJECTIVE
One-stage bilateral, muscle-preserving, calcar-guided implantation technique through the modified minimally invasive anterolateral approach in supine position.


METHODS
Bilateral primary/secondary osteoarthritis of the hip; bilateral femoral head necrosis; ASA I-III.


METHODS
ASA IV; severe osteoporosis, other factors jeopardizing stable anchorage of cementless, calcar-guided short-stem; infection.


METHODS
Supine position. Skin incision. Opening of fascia; blunt dissection, pushing gluteal muscles dorsally with the index finger. Capsulectomy. Individual osteotomy according to preoperative plan to determine short-stem position. Remove femoral head. Prepare acetabulum. Position cup. Femoral preparation with the curved opening awl. Spare greater trochanter and gluteal muscles. Insert trial rasps in ascending sizes with "round-the-corner" technique. Select offset version, then trial reposition with intraoperative radiograph and implantation of the definitive implant. Wound closure. Consultation with the anesthesiologist to confirm a stable patient. Same procedure on contralateral hip.


METHODS
Mobilization on day 1 with immediate full weight bearing. Remove wound drains and urinary catheter (only female patients) on day 2. Intensive protocol of physiotherapy and rehabilitation. Thrombosis prophylaxis. Rehabilitation from day 7.


RESULTS
Almost 500 patients have undergone surgery since 2010. First consecutive 54 patients (108 hips) prospectively evaluated. After 2 years, Harris Hip Score was 98.8; satisfaction on visual analogue scale was 9.9. Low peri- and postoperative complication rates; no implant revisions.


CONCLUSIONS
The muscle-sparing approach and the special "round-the-corner" technique in one-stage bilateral procedure leads to rapid mobilization and rehabilitation with excellent early clinical results and high satisfaction rates.
Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital, Beethovenstraße 20, 65189, Wiesbaden, Germany. kkutzner@joho.de.
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KP
Kutzner
Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital, Beethovenstraße 20, 65189, Wiesbaden, Germany.
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S
Donner
Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital, Beethovenstraße 20, 65189, Wiesbaden, Germany.
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M
Schneider
Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital, Beethovenstraße 20, 65189, Wiesbaden, Germany.
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J
Pfeil
Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital, Beethovenstraße 20, 65189, Wiesbaden, Germany.
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P
Rehbein
D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation* / Q000379:methods* / Q000534:rehabilitation; D006622:Hip Prosthesis; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation* / Q000379:methods*; D056888:Patient Positioning / Q000379:methods*; D011474:Prosthesis Design; D012189:Retrospective Studies; D016683:Supine Position; D016896:Treatment Outcome
Arthroplasty, replacement, hip; Minimally invasive surgical procedures; Optimys; Prostheses and implants; Round-the-corner