TOTAL HIP ARTHROPLASTY VIA THE MINIMALLY INVASIVE ANTEROLATERAL APPROACH (ROTTINGER): QUALITY OF IMPLANTATION AND EARLY COMPLICATIONS IN A CONSECUTIVE SERIES OF 130 PATIENTS

Abstract

Purpose of the study: Survival of a total hip arthroplasty (THA) mainly depends on the choice of the implant and the quality of the implantation. Use of minimally invasive approaches remains a subject of controversy due to the uncertain implant position and questions concerning increased perioperative complications. The purpose of this work was to assess these two elements in a consecutive series of patients who underwent THA implanted via the minimally invasive anterolateral approach described by Rottinger.

Materials and Methods: This was a consecutive series of 130 patients (84 female, 46 male, mean age 69 years, age range 46–91) operated by the same surgeon. Mean follow-up was twelve months (range 6 – 24 months). The clinical parameters studied were: the pre–and post-operative Postel-Merle-d’Aubigné (PMA) score, mean operative time, presence of perioperative surgical complications. Radiographic parameters studied were lucent lines (De Lee and Gruen), homogeneous cementing of the femoral piece, axial position of the femoral implant, angle of acetabular inclination, acetabular anteversion (Hassan), and any leg length discrepancy.

Results: Intraoperative complications were: one intraoperative mobilisation of a press-fit cup, one trochanter fracture. Postoperatively, the rate of dislocation was 2.3%. In 3.8% of the patients developed skin lesions or a local haematoma but none with infection. Mean operative time was 107 minutes (range 80–210). Mean postoperative PMA score was 17.4 versus 12.4 preoperatively. Patients were able to walk without limping 3.3 months postoperatively (range 0.5–12 months). Mean cup inclination and anteversion were 46.1° (28–60°) and 12.3° (0–35°) respectively. Leg length discrepancy was +4.8mm on average (operated side). Femoral alignment was ±3° relative to the femoral axis in 83% of hips. Homogeneous cementing of the femoral stem was noted in 84%. There was a learning curve with an 11% complication rate for the first twenty hips versus 4% for the remainder of the hips in this series.

Discussion: In our hands, the minimally invasive anterolateral approach described by Rottinger enables proper reproducible THA implantation. The rate of intraoperative complications is low. There is a learning curve which was an estimated twenty cases in our series. This method has become our first-intention option for implantation of THA.