The Modified Minimally Invasive Anterolateral Approach for Total Hip Arthroplasty: Surgical Anatomy and Technique of the Approach

Abstract

Minimally invasive surgery (MIS) refers to tissue sparing approach. There are many MIS techniques described for total hip arthroplasty (THA), each one of them having its advantages and disadvantages. In the present chapter the modified anterolateral minimally invasive surgery (ALMIS) technique for THA is described lucidly in a step-by-step manner offering valuable insight and intraoperative tips and tricks. In the modified ALMIS technique, the patient’s positioning differs, as includes removing the anterior leg support from the surgical table, allowing better exposure during femoral preparation that could lead to fewer intraoperative femoral fractures or misplacement of the femoral stem. Furthermore, during the approach, a few anterior fibers (approximately 25%) of the gluteus medius (GM) and the gluteus minimus (Gm) are elevated, enabling better visualization of the acetabulum. The ALMIS technique may be easily extended according to each case, is relatively easy to learn and there is no need for special MIS instrumentation.