Placement of total hip replacements: the contribution of the anterior approach and systematic CT planning

By Dr Yves Rouxel, specialist in orthopaedic surgery, arthroscopy and sports traumatology

The Clinique de l'Alma has equipped itself with a special orthopaedic table for minimally invasive anterior hip replacement.

In addition to systematic 3D planning using a scanner (the one used at the Alma clinic has been specifically configured for this purpose) and the use of modern cementless prostheses, this means that we can look forward to a virtually "forgotten" prosthesis, with over 95% survival at 10 years, free from complications and wear, in patients who are being operated on at an ever younger age (120,000 fittings each year in France).

After 30 years of development, the usual complications of THA, such as loosening and wear, had mobilised research into the implants themselves, but not into how to place them (approach, conventional 2D planning methods).

The challenge, however, is to normalise walking after prosthesis, whatever the patient's age, type of sporting activity or cause of hip joint destruction.

Decisive progress has been made in this area over the last ten years, with :

- the more widespread use of the anterior approach (without any muscle section, which in its minimally invasive form enables THR to be performed with an approach of around 7cm), but which is more technically demanding and requires the use of a special orthopaedic table, available at the Clinique de l'Alma.

- the use of 3D computer planning based on a simple CT scan carried out in the clinic (with specific equipment settings), enabling more precise prediction of the components to be fitted during the operation.

Ultimately, this approach makes it possible to :

- optimise functional results and patient satisfaction for patients who are increasingly sporty and/or demanding, without the need for complicated logistics and on a routine basis.

- make the procedure safer and faster, by increasing its reproducibility (ideal choice and positioning of implants).

- facilitate post-operative rehabilitation, resulting in a shorter hospital stay and more rewarding physiotherapy work for both parties.

- hope for a rapid return to normal life, with a "forgotten" prosthesis, in a patient who is involved and empowered.

- hope for increased longevity of the THP in young, active patients, whose anatomical and biomechanical characteristics will have been restored as well as possible (although the patient should be informed of the greater risk of wear in the event of intensive sports practice).

- avoid foreseeable problems in the short, medium and long term, which guarantees optimum results for both the patient and the treatment team.