Abstract
Background
The increasing desire to protect the periarticular structures led the need of a Tissue Sparing Surgery. The accesses most widely used are the direct-lateral approach and the postero-lateral one, both with patient in lateral decubitus. Aim: This accesses require however an incision of tendons and muscles even in their minimally invasive technique, so we looked for an approach that would wholly protect the periarticular structures and allow us not to revise our experience in patient positioning, preparation of the operating field and surgeon's position during surgery. Our intent was to leave the acquired knowledge unchanged and to preserve unaltered the anatomical landmarks that we had previously identified and consolidated for the correct positioning of the components.
Methods
We have used this approach in more than 180 cases of primary hip arthroplasty. Clinical control includes: Oxford Hip Score, VAS and X-Ray.
Results
OHS mean:44, range 37-48. On X-Ray no signs of components migration, radioucent lines or osteolysis. We didn't have dislocations or other complications.
Discussion
The only approach that safeguard really the periarticular structures is the anterior one (Smith-Petersen), which actually is performed placing the patient in supine decubitus, with obvious difficulties in preparing the operating field and a complete change of the anatomical landmarks. We have combined the advantages of the anterior access with the ones linked to the lateral decubitus. The rewards of this new approach are: easiest preparation of the operating field, no special bed or supports are required, the inferior limb can be easly moved, it is a real tissue sparing approach, good acetabular exposition, surgeon placed traditionally on the posterior side of the patient during the acetabular time.
Conclusion
We have encoded all the steps of this approach that we have called the Anterior Lateral Decubitus Intermuscolar (ALDI) approach.
