Minimally invasive surgery in total hip arthroplasty

Minimally Invasive Hip Replacement vs. Traditional Hip Replacement

---

Free download. Book file PDF easily for everyone and every device. You can download and read online Minimally invasive surgery in total hip arthroplasty file PDF Book only if you are registered here. And also you can download or read online all Book PDF file that related with Minimally invasive surgery in total hip arthroplasty book. Happy reading Minimally invasive surgery in total hip arthroplasty Bookeveryone. Download file Free Book PDF Minimally invasive surgery in total hip arthroplasty at Complete PDF Library. This Book have some digital formats such us :paperbook, ebook, kindle, epub, fb2 and another formats. Here is The CompletePDF Book Library. It's free to register here to get Book file PDF Minimally invasive surgery in total hip arthroplasty Pocket Guide.

The patient was returned to the operating room and had a revision to a distally fully porous-coated stem with a cerclage wire placed around the proximal femur. Another patient complained of persistent groin pain, and 2 weeks postoperation, a calcar fracture was found on a postoperative radiographic scan. The patient was returned to the operating room where revision to a distally fully porous-coated stem and placement of a cerclage wire around the proximal femur through an anterolateral approach was performed.

Both of the patients who sustained calcar fractures recovered fully and went on to full weight-bearing without further incident. Two patients in the two-incision group developed femoral nerve palsies that resolved completely within 12 months.

Introduction

In addition, one patient in the two-incision group had a nonorthopedic complication pulmonary embolism , which was successfully managed with anticoagulation therapy. As mentioned earlier, patients and surgeons have expressed considerable interest in minimally invasive THA approaches. In addition to the two-incision technique described in the present study, standard anterolateral and posterior approaches have been applied through smaller incisions with purportedly less damage to muscles and tendons.

The technical difficulty associated with the two-incision technique has been reflected in increased operative times, both in the present study and in previously published studies.

As reported by the four surgeon developers of the two-incision technique, 14 in operations, 2. As described in the present study, 2 patients 6. We attribute the calcar fractures to the use of a proximal wedge fit stem. Neither fracture was identified in the operating room—one was recognized in the recovery room and the other at 2 weeks postoperation. We believe that these fractures might have occurred with a standard open procedure if the same stem was used.

The femoral nerve palsies, which occurred in 2 patients 6. With use of a rapid rehabilitation protocol among young patients with the procedure occurring as the first of the day, Berger 7 reported sending 97 of patients home the day of the operation. By comparison, patients in the present study who received the two-incision THA were discharged home from the hospital at an average of 2.

It is important to note that we applied the two-incision technique to an unselected consecutive patient population in a community setting and performed these operations in a bed hospital without the major benefits of a dedicated total-joint replacement center. Unique challenges to performing the two-incision THA in a small community hospital include working with different operating room staff on a weekly basis, fewer resources for purchasing newer and more expensive equipment, and less overall surgical volume specific to one single operation.

Physicians performing these operations in high-volume at centers dedicated to total-joint replacement likely do not encounter these situations. We found the two-incision THA procedure to be more difficult than the anterolateral technique. With application of this technique, considerable patience is required for learning by the surgeon. As noted by Bal et al, 9 complication rates and reoperations are likely to decrease with surgeon experience. In addition, not all patients are suitable candidates for this type of minimally invasive procedure. The ideal patient for the two-incision approach is a thin and young patient with low risks for peri- and postoperative complications.

One limitation of the present study was that patients were not randomly assigned to the type of THA approach they received. The retrospective study design and patient selection for the two-incision approach may have led to a bias in the results, though most of the differences between the two groups were not substantial Table 1.

Navigation menu

In addition, because the operations occurred in a general orthopedic practice that serves a small community, there were a limited number of patients. Another major limitation of this study was that in performing the two-incision THA approach, we were early in the learning curve compared to the standard anterolateral approach. As described in other studies, the technical difficulties associated with the two-incision procedure are high, 13 , 15 but operation time and complications may decrease with surgeon experience.

The two-incision THA can be performed in the community setting.

However, surgeons and patients should expect longer operative times and initial increased risk of complications in addition to the reported benefits of two-incision THA. We believe that with increasing experience, time of surgery and complication rates will dramatically decrease. Although we continue to use the two-incision approach in carefully selected patients who request the procedure, we caution them about the increased risk of complications.

Otherwise, we use the standard approach. Financial Disclosures: None reported. Projections of primary and revision hip and knee arthroplasty in the United States from to J Bone Joint Surg Am. Internet promotion of minimally invasive surgery and computer-assisted orthopedic surgery in total knee arthroplasty by members of American Association of Hip and Knee Surgeons.

Minimally Invasive Surgery in Total Hip Arthroplasty

J Arthroplasty. Mini-incision total hip arthroplasty: a comparative assessment of perioperative outcomes. The two-incision minimally invasive total hip arthroplasty: technique and results. Orthop Clin North Am. Anterior approach to hip arthroplasty. Clin Orthop Relat Res. A modified two-incision minimally invasive total hip arthroplasty: technique and short-term results.

Hip Int. The Harris Hip Score after the operation showed that there had been an improvement in both groups, with similar mean scores 86 in the right lateral group versus Aseptic acetabular loosening occurred in one patient, who had been operated by means of the minimally invasive posterior access.

Article Tools

This case underwent revision 12 months after the initial surgery. Revision of the prosthesis was necessary in two of the patients in the control group: the polyethylene in one patient was exchanged after 6. Regarding complications, there were two cases in the minimally invasive group: one of medial acetabular fracturing without displacement, which was treated conservatively; and one of heterotopic ossification, which required surgical resection.

In the control group, there were two cases of femoral fractures, which were treated by means of cerclage during the same surgical procedure; one case of dislocation, which was treated by means of closed reduction, without recurrence; one case of superficial infection, which was treated by means of oral antibiotic therapy; and one case of neuropraxia of the ulnar nerve caused by the positioning on the surgical table, which regressed after eight weeks.

In our study, we noted that the mean age of our patients was lower than seen in studies in the literature, which mostly showed mean ages greater than 60 years. Another possible cause for this finding was perhaps the typical pyramidal age distribution of the Brazilian population, which differs from that of European or North American countries. This lower mean age may represent a source of bias, both toward better recovery from the acute postoperative phase and toward the complications inherent to wear and loosening of the arthroplasty, given that these patients theoretically have a higher degree of physical and work activity.

Other possible sources of bias in the results obtained in the present study include the fact that two prosthesis models were used in both groups, although both models were uncemented. However, most of the studies with large samples have tended to present this same bias. Regarding the control group, the fact that the procedures were performed by different surgeons might also be considered to be a source of bias, although diversity of surgeons has also been reported by a good proportion of previous authors.

The use of prostheses with a tribological pair consisting of a conventional polyethylene insert and a metal head, together with the patients' lower age and consequently higher level of activity, may have been responsible for the linear wear greater than expected that was found in one-third of the cases, and for the early acetabular osteolysis that was found in three patients of the control group. Methods of greater precision such as computerized three-dimensional models are used today, but these were not taken into consideration in the present study because they did not form the authors' main objective.

Regarding the positioning of the prosthesis components, although this was not the main objective of our study, we did not observe any statistically significant difference between the groups. This results from the angle of attack of the acetabular reamer, which is harmful particularly when reamers and impactors that are adapted for smaller accesses are not used Fig.

Weakness of the abductor musculature, as represented by a positive Trendelenburg test, was only found in patients in the group operated by means of a lateral access. Kinematic gait studies have proven that better results are obtained when the access used does not interfere directly with the integrity of this musculature. Most studies have shown that the acute postoperative recovery is better when a minimally invasive access is used, with less bleeding, lower muscle damage and shorter hospital stay.

This denotes a contradiction and a likely underestimate, which has been confirmed by other studies in which the central scope was blood volume loss and the methodology was more detailed for such estimates. Our study, with a follow-up of more than six years, presented results similar to data in the literature on this topic, as demonstrated in a recent meta-analysis, which showed similar evolution in the two groups, both in relation to the radiographic parameters and in relation to the clinical-functional score of the Harris Hip Score, at all the times evaluated.

However, the medium and long-term follow-up seems to be uncertain and inconclusive, given the scarcity of comparative studies with longer follow-ups, and there is no evidence so far regarding the superiority of these accesses in relation to the traditional routes. Overall, in the whole sample, we only observed one case of dislocation. We believe that this low incidence was due to the intensive work conducted by the physiotherapy team of our service, in which postural educational measures were implemented to diminish the risk of this complication. Moreover, in our study, we were only dealing with patients with a diagnosis of osteoarthrosis.

Services on Demand

It is well known that these patients present lower risk than do patients with a diagnosis of fracturing of the femoral neck who undergo total hip arthroplasty. We chose to evaluate overall occurrences of complications per group, in a comparative manner, because the sample size would be insufficient for us to evaluate each comparison in detail according to each type of complication that occurred. The only variable evaluated in this study that showed a significant difference for the minimally invasive access, i.

However, in , Mow et al. In our sample, there were no esthetic complaints, but it needs to be borne in mind that this should be last criterion for indicating a less invasive access. The medium-term clinical and radiographic results and the complication rate are similar for patients undergoing total hip arthroplasty by means of a posterior minimally invasive access and by means of the traditional right lateral route.

• Making Innovation Last: Volume 2: Sustainable Strategies for Long Term Growth
• Alexander Pope’s Catholic Vision: “Slave to no sect”
• Culture of Chemistry: The Best Articles on the Human Side of 20th-Century Chemistry from the Archives of the Chemical Intelligencer
• Data Quality: The Accuracy Dimension (The Morgan Kaufmann Series in Data Management Systems)
• Laser Photodissociation and Spectroscopy of Mass-separated Biomolecular Ions
• Wildmans The Same Ol Page: A Compilation of Essays and Poetry.: Jupiter Effect