Dr Nikolaos Christodoulou
Orthopedic Surgeon MD PhD
Iatriko Psychikou Clinic - Athens
Chief Director of Orthopedic Department
1 Antersen str, 11525 Neo Psyciko - Athens / Greece
NEW SURGICAL TECHNIQUE ( N. CHRISTODOULOU )
Modified ALMIS Hip Approach - New Leg Position During Femoral Preparation
In order to avoid difficulties and excessive capsule or piriformis - external rotators tendons release from inside to mobilise the femur during medullary canal preparation in a hip arthroplasty I have modified Rottinger type minimally invasive anterolateral approach and have achieved easy and safe preparation of the femur almost in all cases of hip arthroplasty in a long series of patients.
With the patient at decubitus lateral position I remove the anterior leg support of the surgical table, stabilise the contralateral leg on the posterior !!! support of the surgical table (not the anterior) and bring the operated leg at slight flexion (to avoid gluteus medius injury), external rotation and adduction position !!! (Not need of the extension leg position of Rottinger or AMIS hip approaches, not need of full hip flexion of Hardinge type lateral hip approach) !
Contralateral leg support abduction of few degrees and slight negative inclination in relation to the longitudinal axis of the surgical table facilitates the femoral preparation in obese patients without need of greater trochanter - capsule, external rotators release also.
New ALMIS Christodoulou Technique : Easy and safe without fractures femoral canal preparation, Short duration anaesthesia and surgery, Diminution of blood loss, Stability, No leg lengthening !
Release of external rotators results in joint laxity. So, there is need of longer arthroplasty head/neck in some lax hips to stabilise the joint and increase the tension on the abductors muscles. This usually leads to operated leg lengthening or need of offset stems to stabilise the hip !!!
New Christodoulou ALMIS Technique : Removal of the anterior leg support of the surgical table, stabilisation of the contralateral leg on the posterior !!! leg support of the surgical table (Not on the anterior leg support used mainly at Rottinger anterolateral approach) and bringing the operated leg at slight flexion (to avoid gluteus medius injury), external rotation and adduction position !!!
Not need of the extension leg position of Rottinger or AMIS hip approaches, not need of full hip flexion of Hardinge type lateral hip approach !!!
Very easy femoral preparation without need of excessive capsular or piriformis release (from inside) to mobilise the femur !
Pictures painting : Maria Kassapoglou
1. "High Hip Center" Technique Using a Biconical Threaded Zweymuller Cup in Osteoarthritis Secondary to Congenital Hip Disease. Nikolaos A. Christodoulou MD, Konstantinos P. Dialetis MD, Athanasios N. Christodoulou MSc. Clinical Orthopaedics Related Research, 468;7: 1912-1919, 2010 (U.S.A.). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2882016/?tool=pubmed
2. Modified Less Invasive and Bloodless Lateral Hip Approach for Total Arthroplasty. N. Christodoulou, K. Dialetis et al. European Journal of Orthopaedic Surgery & Traumatology, 22, 167-174, 2012 ( SPRINGER). http://link.springer.com/article/10.1007/s00590-011-0801-2
3. Non invasive modified anterolateral approach in total hip arthroplasty. Aebi and M. Giraud, Orthopaedics & Traumatology: Surgery & Research, 97, 668—673, 2011. http://www.clinique-pontdechaume.fr/clinique-photos/pdf/protheses-2012/Article-OTSR-UK.pdf
4. The Rottinger approach for total hip arthroplasty: technique and review of the literature. Benjamin et al, Curr Rev Musculoskeletal Med, 4(3), 132-138, 2011. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3261250/
5. Minimally invasive total hip replacement via the anterolateral approach in the supine position. G. Pfluger at al, Int Orthop, 31(Suppl 1), 7-11, 2007 (Piriformis release !!!) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2267524/
6. The Anterior Approach as described by Joel Matta MD Surgical Technique (Obturator internus is cutting, Piriformis ?) http://www.corailpinnacle.net/sites/default/files/2016-04/anterior-approach-surgical-technique.pdf
7. Surgical approach in primary total hip arthroplasty: anatomy, technique and clinical outcomes. S. Petis et al. Can J Surg. 58(2),128-139,2015
“Direct Anterior Hip Approach: In the subset of patients in whom the femur cannot be sufficiently mobilized anteriorly, sequential release of the conjoint tendon and piriformis can also improve mobilization of the femur”!
8. Anterior vs Posterior MIS surgical approaches for total hip arthroplasty. R. Sweet, Louishville, https://www.louortho.com/documents/THR%20-Ant%20Post%20THR%20COMPARISON%20chart%2001-09_2.pdf