The anterolateral MIS-THA approach can be divided into the Modified Watson-Jones approach (MWJ) performed in the lateral position and the Anterolateral Supine method (ALS) performed in the supine position. Femoral preparation is flexible in stem selection in the MWJ method. On the other hand, the ALS method is more stable for placement on the acetabular implant. Now we introduce novel anterolateral MIS approach named AL60, it makes use of the merits of both MWJ and ALS methods. The patient is fixed at 30 degrees on the dorsal side from lateral position. That is 60 degrees on the half side from the horizontal plane, and the platform of the operating table is removed just as in the MWJ method. During surgery, the pelvis is fixed by the posterior support, and the stability of the pelvis is very good. Also, if the inclination is accurate at 30 degrees, by holding the holder parallel to the operating table when inserting the cup, the cup is theoretically inserted at Anatomical anteversion 30 degrees. The intraoperative field of view is also visible to the assistant due to the semi-lateral position. Femoral preparation is easier than the MWJ method because the affected limbs have fallen to the dorsal side already. Since March 2017 to the end of August 2018, the AL60 method was used for 207 primary THA. There were no dislocations or fractures and any other complications. Full weight bearing was possible from the next day. The AL60 method has stability of the ALS method for acetabular preparation and the operability of the MWJ method for femoral preparation. Therefore, it can be said that new AL60 approach method makes use of the merits of both MWJ and ALS methods.Technique
Discussion
Simultaneous bilateral total hip arthroplasty is now widely accepted for their economically and functionally advantages than staged total hip arthroplasty. But there is concerning higher demands of blood transfusion than unilateral procedure. Multiple studies suggest that tranexiamic acid (TXA) reduces perioperative blood loss. However there is no report for simultaneous bilateral total hip arthroplasty in these studies. Hypothesis TXA reduces significant blood loss after bilateral total hip arthroplasty. We retrospectively reviewed the records of 12 patients who did not use TXA, and 12 patients who had used TXA. There were no significant differences between the groups in terms of demographics and preoperative Hb. 1g of TXA was administered just before first skin incision and 1g was administered 6 hours after surgery. Intra operative blood loss, the amount of drainage for the first operative day and perioperative Hb changes were recorded.Introduction
Patients and methods
Conversion of immovable hip to a total hip arthroplasty provides a solution, improving function, reducing back and knee pain, and slowing degeneration of neighboring joints associated with hip dysfunction while the mobilization by total hip arthroplasty is rather uncommon and challenging surgery. Since 1998 we have performed 28 uncemented total hip arthroplasties for arthrodesed or ankylotic Hip. Among them 25 hips in 24 patients (four males and 20 females) with minimum of six months follow-up were evaluated. Thirteen hips were arthrodesed and twelve hips were ankylotic. One patient had arthrodesed hip in one side and ankylotic one in the other side. The mean age at the surgery was 63 (42 to 80). Two patients were Jehovah's witnesses. All 13 arthrodeses had been performed at other hospitals due to developmental dysplasia (11 hips), tuberculous coxitis (one hip), and infection after osteotomy (one hip). The underlying disease for the ankylosis was tuberculous coxitis for one hip and dysplastic osteoarthritis for 12 hips. Spongiosa Metal Cup (GHE, ESKA Orthodynamics AG, Lübeck, Germany) was used for 21 hips (screw fixation was added for two hips), Alloclassic Cup (Zimmer GmbH, Winterthur, Switherland) for one hip, Bicon Plus Cup (Smith & Nephew AG, Rotkreuz, Switherland) for one hip, and Müller's Reinforcement Ring (Zimmer GmbH, Winterthur, Switherland) for two hips. The bearing couple was ceramic on ceramic (Biolox forte, Ceramtec AG, Prochingen, Germany) for 14 hips, ceramic on polyethylene for eight hips, and metal on metal for three hips. Spongiosa Metal Stem (GHE, ESKA Orthodynamics AG, Lübeck, Germany) was used for 15 hips, SL Plus Stems (Smith & Nephew AG, Rotkreuz, Switherland) for nine hips, and Alloclassic Stem (Zimmer GmbH, Winterthur, Switherland) for one hip. All surgeries were carried out through an anterolateral approach. Twelve hips required the adductor tenotomy against the stiffness. The average follow-up period was 3.7 (0.5 to 10.6) years.Introduction
Materials and methods
