Abstract
Aims: To determine the feasibility and short-term outcome after Total Hip Arthroplasty through a limited anterior approach.
Methods: Done between April 2003 and August 2004, 100 patients (102 hips) requiring primary total hip arthroplasty comprise this study. A modification of the Smith-Peterson anterior approach developed by Robert Judet was used requiring a special fracture table (Pro-Fx, OSI) but no unique surgical instruments. A single incision was used; the natural interval between the sartorius and rectus muscles medially and the tensor muscle laterally was developed. SL-Plus stems and Plus-MPF or Encore cups were used in all cases.
This series is entirely unselected: no patients were excluded because of size or body habitus. One third of the patients had a Body Mass Index greater than 30 (obese); the maximum BMI was 45.6. One third had type C bone and nearly one tenth were category 3 anesthetic risks. Average age was 72 (range 39 to 90). A naive definition of “minimally invasive” is met: the average incision length was 9.5 centimeters (range 6.5 to 13).
Result: Time for the surgical procedure reduced from three and one half hours for the first arthroplasty to 70 minutes between the 15th and 20th operation. Previously, hospital stay averaged over 5 days using a conventional posterior approach; average stay with the “minimal” approach was less than 3 days. Only 20% of these patients required an intermediate care facility prior to returning home.
There have been three complications requiring readmission: 1 dislocation, 1 unstable acetabulum, and 1 superficial wound breakdown. There has been a total of 3 dislocations-all within 4 days of surgery, none recurrent. One DVT has been detected.
Conclusions: The early experience, “learning curve” and technical complications of the modified Smith-Peterson anterior approach are emphasized. Given the consistently reported 95% to 98% success rate of conventional hip arthroplasty it is imperative to make any change with foresight and then to document the consequence of that change. Surgical technique should not absolutely dictate implant choice. This report sheds light on the very early result of a change only to the surgical approach to total hip arthroplasty.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
