Material and Methods

Incision starts 1cm distal and 3cm posterior to the ASIS and continues distally for about 8–10 cm along the straightline joining the lateral edge of the patella. It can be extended proximally or distally if necessary. The surgeon is placed posteriorly and the assistant anteriorly. The hip is dislocated with extension and external rotation to osteotomize the femoral neck. During the preparation of the acetabulum the femur is pushed posteriorly with internal rotation. Steinman pins are placed around the acetabulum to improve visualization for reaming and implanting theacetabular components. The femur is then exposed in a simplified way. The operated limb remains on the table. It is adducted above the contralateral limb and rotated outward to allow the femoral metaphysis to protrude. The foot is placed on the edge of the table beside the assistant, the knee is maintained with 45° flexion. The hip capsule is released postero-laterally to improve the femur exposure using Hohman retractors without cutting the short external rotator muscles. Femoral preparation is performed in this position. Once the appropriate implant is selected, the desired head trials are placed. The hip is reduced and the length and stability can be checked with the leg free. In case of isolated cup revision, the femoral head can be conserved. In case of femoral revision, a femorotomy can be easily performed due to the possibility of extended and stable exposure of the femur. Table 1 summarizes the main data of the series.