Screwed cups and short stems in hip

Dr. Nikolaos Christodoulou  who is chairman of  Orthopedic Department in Orthopaedic Surgical Department in Iatriko Psychikou Clinic - Athens Medical Group (Greece). Being an invited keynote speaker at World Congress on Rheumatology & Orthopedics Conferenceheld by Scientific Federation. Dr. Nikolaos Christodoulou is going to talk on ‘Modified ALMIS approach using new generation screwed cups and short stems in hip arthroplasties’. A brief summary is presented here.

One of best MIS hip approaches is at least theoretically Röttinger’s muscles sparing Watson-Jones anterolateral approach in decubitus lateralis position but in our hands difficulties were present, especially during learning curve, to mobilize the femur without excessive supero-medial capsule and external rotators e.g. piriformis and/or obturator internus release in many cases. External rotators release increases hip laxity and longer arthroplasty necks are usually needed resulting to leg lengthening. In the presented personal new ALMIS hip approach for hip arthroplasty the opposite leg is stabilized at the posterior leg table support and not at the anterior that is removed. Only gluteus minimus insertion tendon accompanied by some not important anterior fibers of gluteus medius is temporary elevated and reinserted to its place at the end of operation. No any serious vessel’s branch is present at this approach so blood loss is very minimal. The operating leg is not placed in extension but in small flexion, adduction and external rotation during femoral preparation without stress on abductors. Opposite leg on its support in slight abduction and extension accompanied by slight anterior inclination of the table during femoral access facilitates even more femoral preparation in difficult cases. Excessive capsule or external rotators release is avoided almost in all cases. This approach can be used in all primary or secondary osteoarthritis even in dysplasia or congenital dislocation cases as also in obese patients. In these last cases, skin incision may easily be extended without e.g. lateral cutaneous nerve of the thigh or deep femoral artery branches limitations presented in anterior MIS approaches. Course in 725 patients operated with this new technique in 282 of them using a short curved antirotation uncemented stem in combination with a new generation biologically fixed threaded cup is spectacular compared to classic Hardinge approach cases using classic implants and more successful than our previously published less invasive and bloodless lateral MIS approach for hip arthroplasty. Mobilization and gait is immediate.

For More information: http://scientificfederation.com/rheumatology-orthopedics-2018/