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Approaches to the Hip: Minimally Invasive Direct Lateral Total Hip Arthroplasty

February 01, 2014

Contributors: Francesco Traina, MD, PhD; Raffaele Borghi, MD; Mohammadreza Chehrassan, MD; Daniele Fabbri, MD; Matteo Nanni, MD; Federico Pilla, MD; Andrea Sambri, MD; Sandro Giannini, MD; Cesare Faldini, MD; Cesare Faldini, MD

The aim of this video is to show the surgical technique of modified minimally invasive direct lateral total hip arthroplasty (THA); technique is key to the success of this procedure. THA can be safely performed through a number of surgical approaches. The lateral hip approach first was described by McFarland and Osborne. Hardinge then made a useful transgluteal modification of this approach. Lower incidence of implant dislocation and supine positioning, which makes cup orientation easier and allows an effective intraoperative check of leg length, are advantages of this approach. However, this approach affects the gluteus muscles, which are the most important muscles for hip function during walking and stair climbing. The modified minimally invasive direct lateral was described with the goal of reducing the amount of medius gluteus detachment from the greater trochanter to avoid postoperative gluteus impairment. This approach can be performed without using any particular custom instrumentation, and excellent results can be expected. The modified minimally invasive direct lateral approach may be more difficult to perform for surgeons who are not familiar with hip anatomy (a longer learning curve regarding the posterolateral approach is necessary), and, when mastered, it will be more time consuming. A major concern of the lateral approach is damage to the gluteus muscles that can negatively influence clinical outcomes. Modern mini-invasive approaches provide a tissue-sparing technique for most of the gluteus tendon to reduce postoperative limping and abductor muscle dysfunction. Our results suggest that the modified minimally invasive direct lateral approach greatly diminishes devastating postoperative complications and provides acceptable postoperative stability. The approach provides excellent exposure in primary THA to allow accurate placement of components in an efficient manner.

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