One-stage bilateral implantation of a calcar-guided short-stem in total hip arthroplasty

Abstract

ObjectiveOne-stage bilateral, muscle-preserving, calcar-guided implantation technique through the modified minimally invasive anterolateral approach in supine position.IndicationsBilateral primary/secondary osteoarthritis of the hip; bilateral femoral head necrosis; ASA I–III.ContraindicationsASA IV; severe osteoporosis, other factors jeopardizing stable anchorage of cementless, calcar-guided short-stem; infection.Surgical techniqueSupine 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.Postoperative managementMobilization 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.ResultsAlmost 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.ConclusionThe 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.

Simultaneous bilateral minimally invasive total hip arthroplasty: A comprehensive review of the literature

“…A summary flowchart of our literature search can be found in Figure 1 . This review dealt with one prospective cohort study level III, 2 two retrospective comparative studies level III, 6 , 29 and two retrospective case series 7 , 27 (Table 1 2 , 6 , 7 , 27 , 29 ). We found a complete lack of randomized controlled clinical trials (RCT) of level I.…”

“…The two-stage bilateral total hip arthroplasty (2-BTHA) requires less operative time and less intraoperative blood loss per operation. 2 However, patients need longer rehabilitation time, twice of anesthetic risk and two times admission. 2 …”

“… 2 However, patients need longer rehabilitation time, twice of anesthetic risk and two times admission. 2 …”

“…Different operative techniques were introduced referring to a mininally invasive, muscle sparing total hip arthroplasty (MISTHA) principle. 2 These techniques promise to reduce the intraoperative time and minimize the intraoperative blood loss. 2 , 16 , 17 Except for the mini posterior incision, which shows higher dislocation rate, 18 , 19 the MIS-THA may include the direct anterior approach 20 and the modified Watson-Jones 21 which takes advantage of the anatomical window between the rectus femoris and the abductor muscles.…”

Outcome of an “Enhanced Recovery” Program in Contemporary Total Hip Arthroplasty in Germany

“…One of the strengths of the present study is that it evaluates a group of consecutive patients from a single surgeon. All included patients were given a minimally invasive anterolateral approach and implanted with a short-stem implant [6,21,22]. This minimised the effects on the postoperative outcome of the surgical technique or the surgeonʼs experience.…”