New ALMIS technique for hemi- or total hip arthroplasty with small implants for subcapillary femoral fracture
Minimally invasive approaches to hip arthroplasty
In recent years, many minimally invasive approaches have come to the fore, as an evolution or modification of classic approaches, for performing hemitotal or total arthroplasty for the treatment of displaced subclavian hip fractures (Garden stage III and IV), due to the increased risk of aseptic necrosis of the femoral head and nonunion of the fracture if osteosynthesis is performed.
Advantages of minimally invasive surgery
The minimization of muscle injury, periprosthetic bleeding and other associated complications, as well as immediate standing and walking with the new techniques, resulted in the preference, especially in younger and physically active patients, for total arthroplasty instead of the commonly applied hemiarthroplasty with or without the use of acrylic polymer.
Classical techniques and limitations
Classical techniques of total arthroplasty with large incisions, major injuries and significant bleeding, frequent dislocations, ectopic ossifications or lateral instability of the pelvis were avoided until now for these fractures and hemiarthroplasty was the preferred solution.
Conversion to total arthroplasty
The need to avoid a second-time conversion of hemiarthroplasty to total arthroplasty due to painful hip from wear of the articular cartilage of the acetabular cup from pressure exerted by the metal head, especially in physically active patients (which is a much more serious operation with complications), has led many hip orthopedic surgeons internationally to prefer immediate total hip arthroplasty.
Evolution of techniques and implants
The development of MIS (minimally invasive) techniques and the use of modern small implants with the ability to immediately load and excellent and permanent periprosthetic osteogenesis also contributed to the preference for immediate total arthroplasty.
One of these new techniques is the modified (N. Christodoulou) new ALMIS technique, minimally invasive, which was initially applied at the Psychiko Hospital and is now applied in several orthopedic centers in Greece and internationally.
Surgical technique and materials
The use of a small reversible stem with excellent immediate stabilization and periprosthetic osteogenesis even in several osteoporotic patients, and the use of a special acetabular prosthesis with peripheral anchoring with special wings without the need for screws in almost all cases and without the use of acrylic polymer inside the femoral lumen, improved the postoperative result even further.
Education and reference centers
The Orthopedic Clinic of the Psychiko Medical Center, directed by Mr. Christodoulou, has been established as a surgical training center (Surgeon to Surgeon Training Center) in Europe in this technique by the orthopedic implant company in Europe (Lima Corporate) and several dozen orthopedic specialists specialized in hip arthroplasty from Greece and abroad have participated so far in the above training.
X-ray before and after displaced subclavian hip fracture:
Fracture of the femoral neck in the hip in a 60-year-old female patient, quite displaced (Garden IV).
Minimally invasive ALMIS method (modified by N. Christodoulou) with anesthesia only of the lower extremities (subarachnoid), with a very small incision of the skin and soft tissues. Short procedure with almost no blood loss and of course no blood transfusion or need for a bladder catheter, use of small implants with minimal bone damage with the possibility of permanent periprosthetic osteogenesis, without the use of screws or the use of acrylic polymer.
Special suturing of the small skin incision with bio-absorbable sutures that do not require removal.
Immediately up and walking on the same day.
