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Die standardisierte Implantation einer Hüfttotalendoprothese über einen Zwei-Inzisionen-Zugang („Yale-Technik“)

The Standard Implantation of a Total Hip Prosthesis Via Two Incisions (the Yale Technique)

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Zusammenfassung

Operationsziel

Implantation einer Hüfttotalendoprothese mit minimaler Traumatisierung der umgebenden Weichteile und ohne intraoperative Bildwandlerdarstellung und/oder Navigation.

Indikationen

Alle Formen der Koxarthrose in jeder Altersklasse, mit jeder knöchernen Konstitution und selbst bei massiv übergewichtigen Patienten.

Kontraindikationen

Hochstehende Dysplasiekoxarthrosen mit Ausbildung einer Sekundärpfanne, die eine knöcherne Rekonstruktion des Pfannenerkers (z.B. in dem Verfahren nach Harris) erfordern.

Operationstechnik

In fixierter Seitenlage wird über einen kleinen ventralen Zugang zwischen den Sehnen des Musculus tensor fasciae latae und des Musculus sartorius das Pfannenimplantat platziert. Über einen zweiten dorsalen Zugang wird nach Ablösung der Außenrotatoren der Schaft implantiert, und die Prothetik wird gekoppelt.

Weiterbehandlung

Sofortige Vollbelastung möglich.

Anlegen eines speziellen selbstentwickelten Hüftmieders, der sog. Yale-Bandage, zur Luxationsprophylaxe bis zum Abschluss der 4. postoperativen Woche.

Entlassung aus der stationären Behandlung nach wenigen Tagen. Eine stationäre oder ambulante Rehabilitationsmaßnahme von ca. 3 Wochen schließt sich an. Die Rückkehr an den Arbeitsplatz mit zunächst leichter körperlicher Arbeit ist bereits nach Wundheilung ca. 14 Tage postoperativ möglich.

Kontrollen werden nach 4 Wochen, nach 6 Monaten, nach 1 Jahr und anschließend jährlich klinisch, radiologisch und laborchemisch durchgeführt. Sportliche Belastung und schwere körperliche Arbeit werden üblicherweise nach der 6-Monats-Kontrolle freigegeben.

Ergebnisse

Zwischen Oktober 2004 und April 2006 wurden insgesamt 221 Patienten unter Einsatz der neuen Technik operiert (davon 15 Patienten doppelseitig zweizeitig). Der Nachuntersuchungszeitraum betrug minimal 12 und maximal 30 Monate. Der Harris-Hip-Score verbesserte sich von durchschnittlich 45,25 präoperativ auf 96,4 postoperativ.

Abstract

Objective

Implantation of a total hip endoprosthesis with minimal trauma to the soft tissue. The need for visual aids (e.g., navigation or X-rays) during the procedure is frequently avoided.

Indications

All kinds of coxarthrosis for every age group, for every variation of bone construction, and even in obese patients.

Contraindications

Extremely dysplastic hip joints involving the development of a secondary socket and the necessity of reconstruction of the acetabular socket (e.g., in the Harris method).

Surgical Technique

Using a fixed lateral position, a small entry incision is made between the tensor fasciae latae and the sartorius muscles and the prosthesis socket is put into place. Via a second dorsal incision, after stripping the exterior rotators, the prosthesis stem and ball are implanted and the two parts of the prosthesis are attached.

Postoperative Management

Full weight bearing allowed immediately. A luxation prophylaxis, in the form of a self-developed hip bodice (the so-called Yale bandage), is used until the end of the 4th postoperative week. Discharge from hospital is possible after just a few days. Upon discharge, the patient is sent to a rehabilitation facility, either as a resident or as an outpatient, for approximately 3 weeks. Return to the workplace, with only light physical activity, is possible once the wound has healed completely; this could be as soon as 14 days after the operation. Checkups are made after 4 weeks, 6 months, 1 year and then every year; these checkups include a full examination, X-rays and laboratory tests. Full exposure to sport or heavy manual labor is usually approved after the 6-month checkup.

Results

Between October 2004 and April 2006, a total of 221 patients underwent surgery using this new technique (of these 15 patients underwent two-stage bilateral hip joint replacements). Patients were followed up for a minimum of 12 months and a maximum of 30 months. The Harris Hip Score improved from an average of 45.25 preoperatively to 96.4 postoperatively.

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  1. Abteilung für Orthopädie und Endoprothetik, WolfartKlinik München-Gräfelfing, München-Gräfelfing, Germany

    Robert Kipping

  2. OrthoPraxis, Bahnhofstraße 5, 82166, Gräfelfing/München, Germany

    Robert Kipping

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Kipping, R. Die standardisierte Implantation einer Hüfttotalendoprothese über einen Zwei-Inzisionen-Zugang („Yale-Technik“). Orthop Traumatol 21, 335–348 (2009). https://doi.org/10.1007/s00064-009-1809-1

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