Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2009; 76(4):276-280 | DOI: 10.55095/achot2009/051

Zkušenosti s dvouincizní minimálně invazivní technikou náhrady kyčelního kloubu u 150 případů s použitím impantátu s proximální hydroxyapatitovou povrchovou vrstvouPůvodní práce

D. WOHLRAB^1,*, N. SOTEREANOS²

¹ Department of Orthopedic Surgery Martin Luther University Halle-Wittenberg, Halle, Germany

² Allegheny General Hospital, West Penn Allegheny Health System, Division of Adult Reconstruction and Joint Replacement, Pittsburgh, PA (U.S.A)

BACKGROUND:
In this retrospective study we describe our experiences in minimally invasive two incision total hip replacement (THR).

METHODS:
We performed 150 fluoroscopy-assisted two incision minimally invasive THR on 148 patients using a proximally coated hydroxyapatite implant. Clinical (Harris Hip Score (HHS), surgical time, blood loss, length of hospital stay) and radiographic data (leg length discrepancy, cup abduction angle, stem alignment) were collected.

RESULTS:
The HHS increased from 54.7 preoperatively to 92.6 postoperatively. Mean surgical time was 103 minutes. Mean intraoperative blood loss was 410 ml. There were 11 (7.3%) complications including two dislocations (1.3%), one deep wound infection (0.7%), three minor calcar fractures (2.0 %), one periprosthetic femur fracture (0.7 %), two subsided stems (1.3%) and two femoral nerve palsies (1.3%). One of the femoral nerve palsies remained unresolved. The prevent femoral nerve palsies we used somato-sensory evoked potentials (SSEP) after the 48th case and there were no further nerve palsies. Ten complications were in the first 48 cases. In the first 28 cases the anterior skin incision was parallel to the femoral neck and then changed to parallel the intertrochanteric line. Mean length of stay was 2.2 days. Mean cup abduction angle was 39.4° and mean cup anteversion was 34.6°.

CONCLUSION:
The initial complication rate can be related to the learning curve using a new surgical technique. In the subsequent 102 surgeries there was one stem subsidence.
The minimally invasive approach in THA remains new technique and carries additional risks. Secondary to the learning curve comparable short and long term follow up's are necessary.

Klíčová slova: minimal invasive, total hip arthroplasty, two incision technique, cementless THR

Zveřejněno: 1. srpen 2009  Zobrazit citaci