The Anterior Approach – a logical approach for minimally invasive surgery
What is the AMIS Anterior Approach?
AMIS (Anterior Minimally Invasive Surgery) is a surgical technique used in total hip arthroplasty (THA). It involves accessing the hip joint through an anterior approach, following an intermuscular and internervous path, which minimises damage to surrounding tissues like muscles, tendons, and nerves. By preserving muscles, tendons, and nerves, this approach is designed to reduce trauma to the body, improving the overall recovery process for patients.
Intermuscular Approach
- Sartorius
- Fasciae Latae Tensor
- Vastus Lateralis
- Rectus Femoris
- Gluteus Minimus
- Iliopsoas
Types of Surgical Approaches in Total Hip Arthroplasty
Compared to traditional approaches, the anterior approach is a minimally invasive and muscle-sparing technique.
Advantages of the Surgical Technique
The AMIS Anterior Approach technique offers several advantages, including:
- Significantly shortened rehabilitation [1]
- Faster return to daily activities [2]
- Decreased post-operative pain [3]
- Immediate post-operative muscle tone preservation [4]
- Decrease in blood loss [4]
- Shorter hospitalisation [4]
- Reduced risk of dislocation [2,3,4]
- Component placement with the anterior approach is more often in the “safe zone” than with other approaches [5]
MRI one year post-op [5]
These advantages are predominantly experienced by patients in the short-term, however, the approach may deliver potential medium to long term benefits [8,9]:
Literature shows that with the AMIS anterior approach:
- Patients feel no residual trochanteric pain or limping [6]
- There is a reduced risk of muscle degeneration [6]
- There are potential advantages for revision surgery [7, 8]
Surgical Options & Benefits
Today, there are different approaches to hip replacement surgery. One such method is the AMIS Anterior Approach, which offers several benefits.
Minimally Invasive
It avoids cutting major muscles, resulting in less post-operative pain and faster recovery.
Faster Recovery
Patients often experience quicker return to normal activities compared to other methods.
Primary Acetabular
Medacta offers a comprehensive range of cementless and cemented acetabular solutions for Primary Hip Replacement, designed to meet modern surgical challenges and to address the specific needs of each patient. Supported by excellent clinical heritage, Medacta’s acetabular hip cups feature several shell versions and multiple bearing options, including extensive single-mobility components, cobalt-free double mobility options and advanced monoblock solutions. By leveraging cutting-edge materials and coating, as well as a proprietary 3D-printing technology, Medacta acetabular systems offer the surgeons the confidence needed to achieve high standard stability and positive patient outcomes.
The Apricot cemented acetabular cup has a flat rim and it is circumferentially ridged and radially grooved to improve the cement adhesion. The external flange contains a stainless steel wire as reference for cup orientation and wear measurement during radiograph evaluation.
Product Range
The UHMWPE cemented acetabular cup is available with an inner diameter of 22, 28 and 32mm.
The Mpact DM is part of the Mpact Acetabular System and offers different shell and liners options, ranging from primary to complex revision solutions. The Mpact DM is a hemispherical dual mobility cup, which is used with Highcross UHMWPE liners. The MectaGrip Ti coating provides a high friction and scratch-fit feel that improves the initial stability. Additionally, the high porosity allows for bone ingrowth, thus providing secondary fixation.
The Mpact Double Mobility prosthesis is designed for use in total hip arthroplasty to provide increased patient mobility and reduced pain by replacing the damaged hip joint, in primary or revision surgery.
Total hip arthroplasty is indicated in the following cases:
- Severely painful and/or disabled joint as a result of arthrosis, traumatic arthritis, rheumatoid polyarthritis, or congenital hip dysplasia
- Avascular necrosis of the femoral head
- Acute traumatic fracture of the femoral head or neck
- Failure of previous hip surgery: joint reconstruction, internal fixation, arthrodesis, partial hip arthroplasty, hip resurfacing replacement, or total hip arthroplasty
Instability is still a major challenge and a significant issue for both primary and revision total hip arthroplasties, but Double Mobility (DM) devices can provide a viable solution.[1-3] To date, most of the Double Mobility Converters on the market are made of Cobalt-Chromium alloy, with several papers reporting corrosion of the taper connection.[4,5]
Medacta’s focus on improving the patient’s well-being through innovative solutions has led to the development of the SensiTiN Double Mobility Converter, a High Nitrogen Stainless Steel completely cobalt-free modular DM device with an outer Titanium Nitride coating to improve corrosion resistance.
Primary Stems
Medacta offers a comprehensive range of cementless and cemented femoral solutions for Primary Hip Replacement, designed to meet modern surgical challenges and to address the specific needs of each patient. Supported by remarkable legacy and clinical heritage, Medacta’s femoral hip stems feature an extensive range of sizes, multiple offset options, different stem lengths and canal-filling dimensions, as well as cutting-edge coatings. They incorporate features which simplify their use in combination with minimally invasive approaches. This versatility allows for the restoration of native hip joint biomechanics across diverse patient populations.
The P-Family Hip System is a comprehensive system of cutting-edge rectangular triple-tapered stems featuring three distinct design options: SMS, AMIStem-P and QUADRA-P. The restoration of an individual hip anatomy and biomechanics in a heterogeneous population is one of the main challenges that orthopaedic surgeons face today [1]. With the increasing number of THA in active and young patients, better performing implants are required [2]. By always keeping in mind patient care and well-being, Medacta has developed the P-Family Hip System to address these challenges, helping surgeons to achieve surgical excellence.
The AMIStem has been developed to facilitate broaching and stem insertion when utilising the AMIS approach without compromising implant stability. Based on the clinical experience of straight, rectangular, cementless hip stems,[1,2,3,4] the AMIStem incorporates features which simplify the AMIS approach.
Product Range
Redefining THR: The AMIS Synergy
The anterior approach, strengthened by years of clinical experience, is the only technique which follows a path both intermuscular and internervous and therefore reduces considerably the risk of damaging periarticular structures such as muscles, tendons, vessels and nerves. Medacta International is the world leader for educating and supporting surgeons in their pursuit of Anterior Minimally Invasive Surgery (AMIS).
Reference Centers, located throughout the world, provide the necessary AMIS educational experience and Medacta offers continuous support for surgeons, as well as constantly improving and developing the industries most specialised instrumentation platform.Using AMIStem you can enter Medacta International’s world of AMIS.
Discover:
- The definitive MIS approach: AMIS;
- Dedicated AMIS instrumentation;
- The AMIS Mobile Leg Positioner: the original orthopaedic extension table included as part of the instrumentation that makes the surgery easier and reproducible;
- The AMIS Education Program is based on Medacta’s proven educational methods.
The concept of tapered wedge femoral stems has been shown to provide excellent implant stability in short term, mid term and long term clinical studies.[1,2,3] The MasterLoc Hip System follows this philosophy, presenting a novel proximal coating – Mectagrip, designed for initial stability and long term fixation. With an optimised design, the MasterLoc Hip System is suitable for all MIS procedures, especially the AMIS approach.
Product Range
The philosophy of anatomical stems was introduced into the market during the 1980’s with the aim to obtain the best press-fit in the metaphyseal femur using a design following the natural geometry of the proximal femur. The MiniMAX is an anatomical cementless stem engineered to provide the best fit and fill in the metaphyseal femur following the natural shape of the femoral canal. [1,2] The length of the stem and the shape have been studied size by size and have shown to be bone preserving and to provide good mechanical stability. [3]
Why MiniMax?
- Minimal risk of impingement and fracture thanks to the lateral flare design
- Reduced risk of thigh pain thanks to the unique tip design
- Easy to introduce thanks to optimal stem curvature
- Metaphyseal fixation thanks to proximal Ti & HA coating
X-acta is a cemented double-tapered stem manufactured in high-nitrogen stainless steel, provided with a PMMA distal centralizer to facilitate stem positioning and uniform cement mantle distribution. On the basis of its clinical success, a 2.5 mm shortened X-acta stem was designed to facilitate stem implantation through the AMIS approach and reduce bone removal. The collarless, double-tapered, polished design that inspired the X-acta stem has proven successful for more than 45 years of Total Hip Replacement (THR).
Single Proven System
As a collarless stem, X-acta allows surgeons to intra-operatively accommodate most patient anatomies and indications, including fracture, primary and revision cases. It may be chosen as the SOLE system for a surgeon’s practice.
User-friendly Design
Three depth markings spaced 4 mm apart are etched on the proximal part of the X-acta stem. The markings allow for the correction of the leg length by adjusting the depth of the stem insertion. The same markings are also indicated on the rasps. The X-acta stem is provided with a winged PMMA distal centralizer that facilitates the stem positioning and optimizes the load transfer.
A complete range of straight stems with 20+ years of clinical success
Quadra System is a straight stem complete system for use in primary and revision surgery:
- Effective stability thanks to the triple tapered design
- Wide range of sizes
- Reliable, compact and precise instrumentation
- AMIS friendly design
Straight Cementless femoral stems have demonstrated, through 20 years clinical follow-up, to be able to withstand biomechanical stresses by showing exceptionally good “survival rates”. [1,2,3] With a clinical history starting in 2003 and thousands of stems implanted each year worldwide, the Quadra System stems have proved to be a reliable solution for almost every indication of Hip Arthroplasty. [4]
Revision Hip Portfolio
The Medacta Hip Revision Portfolio offers a complete set of femoral and acetabular solutions empowering the surgeons to restore the patient’s anatomy even in highly complex hip revision surgeries. Hip revision surgeries are known to be complex and unpredictable. Medacta has designed an optimized Revision Hip Platform, MAXIMIZING THE VERSATILITY of implants and instruments, while MINIMIZING THE COMPLEXITY of the surgical flow.
M-Vizion is Medacta’s modular femoral revision system designed to address from demanding primary to complex revision cases in a versatile and flexible manner. M-Vizion has been conceived with a Smart Modular Thinking to address the main challenges and surgeon needs in femoral revision surgeries.
Strong Modular Junction
The M-Vizion stem features an exclusive mechanical design to increase the taper’s resistance to one of the main complications, fretting-induced fractures[1,2,3,4,5], providing for higher stability at the modular junction. The high taper mechanical resistance and conical connection strength also offer an improved resistance to fretting-induced fractures.[6]
High Flexibility
A total length of 193 to 323 mm, with different possible combinations to address different femurs.
User-friendly Instrumentation
M-Vizion features straightforward instrumentation, engineered to simplify the surgical technique and maximize efficiency, confidence and reproducibility.
- Streamlined Trials: reduce the surgical steps and surgical time
- In vivo and backtable assembling options: offer the opportunity to choose the preferred surgical technique
- Millimetric Graded Reamers: allow for a step-by-step accurate and precise preparation, respecting the bone
Product Range
Quadra-R is a cementless straight long stem for revision purposes or pertrochanteric fractures. Based on the Quadra-H, Quadra-R provides the stem with a longer and larger distal shaft for greater distal stability in the femoral cavity. It shares most of the characteristics of the cementless options. Quadra-R is available with a dedicated instrumentation tray.
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