Antero-lateral minimal invasive (ALMI) approach for total hip arthroplasty technique and early results

Introduction: Minimally invasive surgery represents one of the most recent techniques to have emerged within THA. In conventional THA, the incision typically measures 15-20 cm. Minimal invasive approach defined as less invasive to the skin, muscles, or bone may reduce complications and improve recovery time. A number of different approaches and methods have been described in literature. Purpose: This is a prospective study describing the technique and early results of the modified antero-lateral minimal invasive (ALMI) approach and comparing our results to the results of other investigators interested in minimal invasive THA. Materials and methods: Seventy-five consecutive primary total hip arthroplasties (cemented and cementless) were done through a modified ALMI approach (6-8 cm), in which we kept the hip abductors intact. Neither special instruments nor specially designed prostheses were needed. Minimum follow-up was 12 months. Results: The mean Harris hip score for patients after 12-month follow-up was 90 while the mean Merle d'Abugine mean score was 16.5. Both scores reached almost the maximum values within 3 months after surgery. The cup abduction angle for 70% patients was between 35 degrees and 45 degrees. No femoral stem mal-alignment was recorded. The mean operative time of cemented prosthesis was 65 min while that of the cementless prosthesis was 55 min. No wound complications or dislocations were recorded. All the patients were allowed to weight bear in the second post-operative day and involved in an early rehabilitation program. Conclusion: ALMI hip approach with sparing of hip abductors is safe and gives excellent orientation for positioning of prosthesis components. It also allows early and smooth post-operative rehabilitation with fast recovery of the patient in terms of weight bearing.