( Antero – Lateral – Minimally – Invasive – Surgery ) / Excellent Results !

The term  M.I.S. “Minimally Invasive Surgery” is used for various new hip arthroplasty techniques of single or dual, anterior, lateral, anterolateral or posterior skin incision.

Anterior incision has been established as A.M.I.S. (Anterior – Minimally – Invasive – Surgery) and the Anterolateral as A.L.M.I.S ( Antero – Lateral – Minimally – Invasive – Surgery). Their mutual feature comprise small incision along with minimal muscular intervention.

Their differences are related to access mode and intraoperative or postoperative complications.

Despite initial enthusiasm, complications of some of these techniques –i.e. A.M.I.S.- that mainly involve femoral cutaneous nerve injury, femoral or ankle fractures from excessive traction or wrong implants’ placement etc. created the need to modify some of these techniques with emphasis on avoiding internal injuries but also on how well implants are placed.

To avoid wrong implants’ placement through small incisions due to limited visibility difficulties, robotic systems were also used. However, the great time required  to install these systems while the patient was under anesthesia along with surgery’s complexity, additional problems were created.

To avoid these obstacles and complications, Dr Christodoulou – with extensive experience in hip and knee arthroplasty – with the collaboration of Dr K. Dialetis, improved and transformed the French  ‘Thomine’ technique into the new A.L.M.I.S. arthroplasty ( Anterior – Lateral – Minimally – Invasive – Surgery). Thus, the new A.L.M.I.S. technique is simpler, less invasive, safer and almost bloodless in most cases.

With the new A.L.M.I.S. arthroplasty, skin incision is small at the lateral region of the upper thigh and internally is not extended at the vastus lateralis muscle and its vessels. Branches of the deep femoral artery are not injured likewise those of the anterior or lateral circumflex artery; that are usually injured on Hardinge type incisions, neither the upper gluteal vessels and nerves. In most cases, no hip muscle is incised while in most difficult cases the frontal 1/3 or ¼ part of the gluteus medius muscle is reflected and reattached; by neither participating nor affecting hip abductive activity. This temporary reflexion decreases medius gluteus muscle fibers’ and upper gluteus nerve branches’ strain – latter of which, may be injured by surgical retractor’s increased strain.

In addition to that, hip external rotation muscles are not incised; neither do piriformis anr pyramidal muscles. However, according to Clinical Orthopedics and Related Research American Journal formal puplication both piriformis and pyramidal muscles are injured and incised extensively with anterior type A.M.I.S. and posterior hip arthroplasties.

In particular, at Clinical Orthopedics and Related Reserch: December 2006 – Volume 453, p.p. 293-298 is mentioned that during anterior minimal invasive hip surgery –i.e. A.M.I.S. – Smith Petersen type – the muscle tending towards fascia lata has been injured by 31%  while reflected tendon of rectus femoris by 12%. In 50% of these referred cases, piriformis muscle was cat to mobilize femur bone.

Combing the latest and most improved biomaterials – such as acetabular prosthesis of biocompatible titan implant type Zweymuller with special wards instead of screws or acrylic cement- thiw technique offers direct fuctional rehabilitation even in greatly destroyed hips sush as cases that involve common osteoarthritis or disclotation of the hips.

Study of Dr. Christodoulou and Dialetis presenting excellent results of applying these pre-mentioned implants in dysplastic or congenital dislocated hips, were published at the American Journal ‘’Clinical Orthopedics and Related Reserch’’, 468:1912-1919,2010 (U.S.A).

Direct intraoperative strong retension and stability of biological embedded bone acetabular components of titanium, with special wards for direct intraoperative retension with rotation, allows full wait bearing and gait from even the first day – since there are no other co-existing diseases or problems in other joints – while ascending and descending the stairs within a day or two, with or assistance.

These new biocompatible implants provoke strong and permanent periprosthetic osteointegration as not to have any further problem at the surface among implant and bone for the rest of the patient’s life.

In conclusion A.L.M.I.S. achieves:

  1. longevity of the new joint – i.e. it’ well known that patients are concerned about how many years will total arthroplasty last.
  2. Minimized bleeding – i.e. patients usually do not need blood transfusion unless they suffer from anemia or are prone to hemorrhage.
  3. Minimized muscular, vascular and neural injuries around the hip lesion.
  4. Less surgical time and sedation – i.e. surgery usually does not exceed one hour, lessening thus rate of infection or thrombosis incidence.
  5. Small incision – adjusted to each patient at the lateral non visible part of the femur without stressing soft tissue and forcing strong attraction of the leg at risk of fracture, in a specialized surgical table; exactly like performed at the advertised A.M.I.S. technique.
  6. Rapid patient rehabilitation – i.e. most patients may climb stairs almost immediately after operation while exit hospital within 1-3 days.
  7. Rare or not significant complications compared to other techniques on which heavy may appear like hemorrhage that requires numerous bottles of homologous blood, thrombosis, dislocations, material softening, etc. 

The new A.L.M.I.S. arthroplasty has been successfully applied during three last years in Greece at Medical Center of Athens, Iatriko Psychikou Clinic, by Dr. N. Christodoulou and his colleague K. Dialetis. More information about the new A.L.M.I.S., modified French “Thomine” technique, may be found at url: 

International study of Dr N. Christodoulou, K. Dialetis and associates presenting excellent results of A.L.M.I.S. hip arthroplasty technique has been published [ 2012 ] at “European Journal of Orthopaedic Surgery and Traumatology” – SPRINGER publications.

ALMIS Anterolateral Hip Approach Using a Different Table and Legs Position during Femoral Exposure; New Surgical Technique. N. Christodoulou. MOJ Orthopedics & Reumatology, Volume 7, Issue 4, 2017. (USA) :