Abstract
The minimally invasive total hip replacement has been developed over the last years.
The advantages of minimally invasive approaches concern reduced blood loss and pain, shorter operative time, reduced length of stay, facilitated rehabilitation and increased patient satisfaction. Potential disadvantages are the need for additional training and patient education, the insufficient clinical data and the risk of compromising the final result by giving more importance to the length of incision than to the damage of the deeper tissue.
In the majority of cases, the minimally invasive techniques utilize standard prosthesis and resection of pathological tissue, including part of normal bone such as the femoral neck.
LINK MIT-H permits combining a minimally invasive approach with the insertion of a T.O.P. acetabular cup and a CFP femoral prosthesis, preserving the femoral neck. The conservation of this anatomic part facilitates a shallow entry of the prosthesis in the femoral canal, preserving the bone stock and thereby allowing a more precise reconstruction of the hip geometry. The technique appears to give good results, associating the advantages of minimally invasive surgery with the preservation of the femoral neck.
The good relation between the abductor lever arm and the adductor lever arm guarantees an elevated functional restoration, allowing a favorable and durable result in time.
The LINK MIT-H technique may be utilized with a direct lateral or through a post-lateral approach. We prefer a lateral approach, usually utilizing general instruments such as hooks and Hohmann retractors where the width of instruments is adapted to the length of incision.
A corkscrew may be useful to take out the femoral head, cutting it in the narrow part of the neck. Stein-mann pins, placed at the cranial acetabular rim as self-retaining retractors, associated with two Hohmann retractors below, allow good vision and facilitate reaming the socket. The attachment of fibre optics on the retractors is useful to have more light inside. Straight or cranked shaft instruments are very well suited in reaming and in aligning the T.O.P. acetabular cup.
The minimally invasive technique gives the best results when damaging tissues as little as possible by using a less invasive prosthesis that is easily implanted in small spaces and only replaces the pathologic bone, thereby saving the bone stock best as possible in restoring the hip geometry.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
