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Herkömmliche vs. minimal-invasive Hüftendoprothetik

Eine prospektive Studie über Rehabilitation und Komplikationen

Conventional vs minimally invasive total hip arthroplasty

A prospective study of rehabilitation and complications

Der Orthopäde volume 35, pages 761–768 (2006)Cite this article

Zusammenfassung

Hintergrund

In einer prospektiven, nicht randomisierten Studie wurden die Ergebnisse hinsichtlich Rehabilitation und Komplikationsrate von Hüftendoprothesen verglichen, welche entweder mittels einer gewebeschonenden Technik, der sog. superioren Kapsulotomie (Studiengruppe), oder eines konventionellen Zugangs, des direkten lateralen Zugangs (Kontrollgruppe), eingesetzt wurden.

Patienten und Methoden

Die Studiengruppe bestand aus 106 Patienten, die Kontrollgruppe aus 107 Patienten. Beide Gruppen zeigten keine Unterschiede bezüglich Alter, Geschlecht, Diagnose oder Body-Mass-Index (BMI).

Resultate

Die Studiengruppe zeigte eine statistisch signifikant akzelerierte Rehabilitation nach 6 Wochen (p<0,001) sowie eine niedrigere perioperative Komplikationsrate.

Schlussfolgerung

Die vorliegende Studie zeigt, dass weniger invasive chirurgische Techniken in der Hüftendoprothetik mit der Philosophie von größtmöglicher Schonung der Abduktorenmuskulatur, der posterioren Kapsel und der kleinen Außenrotatoren in einer sichereren Operation mit beschleunigter Rehabilitation resultieren können.

Abstract

Background

In a prospective, nonrandomized study the outcome in terms of rehabilitation and complications of total hip arthroplasty (THA) through a superior capsulotomy exposure (study group) was compared to THA performed through a direct lateral exposure (control group).

Patients and methods

The study group (106 THA) and the control group (107 THA) were controlled for complexity and had no significant differences in age, sex, diagnosis, or body mass index.

Results

The study group had improved recovery at 6 weeks after surgery which was statistically significant (p<0.001). In addition, the study group had a lower incidence of perioperative complications.

Conclusion

The current study demonstrates the potential that less-invasive surgical techniques with the philosophy of maximally preserving the abductors, posterior capsule, and short rotators may result in a safer operation with an accelerated recovery.

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Literatur

  1. Berry DJ, Berger RA, Callaghan JJ et al. (2003) Minimally invasive total hip arthroplasty. Development, early results, and a critical analysis. J Bone Joint Surg Am 85: 2235–2246

    PubMed  Google Scholar 

  2. Feinblatt JS, Berend KR, Lombardi AV Jr (2005) Severe symptomatic heterotopic ossification and dislocation: a complication after two-incision minimally invasive total hip arthroplasty. J Arthroplasty 20: 802–806

    Article  PubMed  Google Scholar 

  3. Gore D, Murray P, Sepic S, Gardner G (1982) Anterolateral compared to posterior approach in total hip arthroplasty: difference in component positioning, hip strength, and hip motion. Clin Orthop Relat Res 165: 180–187

    PubMed  Google Scholar 

  4. Hartzband MA (2004) MIS THA: the New Jersey experience and how to choose. In: DiGioia AM (Hrsg) Proceedings MIS meets CAOS, April 16–17, Pittsburgh, PA, pp 159–174

  5. Kennon RE, Keggi JM, Wetmore RS et al. (2003) Total hip arthroplasty through a minimally invasive anterior surgical approach. J Bone Joint Surg Am 85(Suppl): 39–48

    Google Scholar 

  6. Light TR, Keggi KJ (1980) Anterior approach to hip arthroplasty. Clin Orthop Relat Res 152: 255–260

    PubMed  Google Scholar 

  7. Mardones R, Pagnano MW, Nemanich JP, Trousdale RT (2005) The Frank Stinchfield Award: Muscle damage after total hip arthroplasty done with the two-incision and mini-incision techniques. Clin Orthop Relat Res 441: 63–67

    Article  PubMed  Google Scholar 

  8. Merle d’Aubigné R, Postel M (1954) Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg Am 36: 451–475

    PubMed  Google Scholar 

  9. Morrey BF (1992) Instability after total hip arthroplasty. Orthop Clin North Am 23: 237–248

    PubMed  Google Scholar 

  10. Murphy SB (2004) Technique of tissue-preserving minimally-invasive total hip arthroplasty using a superior capsulotomy. Oper Techn Orthop 12: 94–101

    Article  Google Scholar 

  11. Murphy SB (2004) Tissue-preserving, minimally invasive total hip arthroplasty using a superior capsulotomy. In: Hozak W (ed) Minimally invasive total hip and knee arthroplasty. Springer, Berlin Heidelberg New York Tokio, S 102–107

  12. Pagnano MW, Leone J, Lewallen DG, Hanssen AD (2005) Two-incision THA had modest outcomes and some substantial complications. Clin Orthop Relat Res 441: 86–90

    Article  PubMed  Google Scholar 

  13. Roberts JM, Fu FH, McCain EJ, Ferguson AB (1984) A comparison of posterolateral and anterolateral approaches to total hip arthroplasty. Clin Orthop Relat Res 187: 205–210

    PubMed  Google Scholar 

  14. Tannast M, Langlotz U, Siebenrock KA et al. (2005) Anatomic referencing of cup orientation in total hip arthroplasty. Clin Orthop Relat Res 436: 144–150

    Article  PubMed  Google Scholar 

  15. Waldman BJ (2002) Minimally invasive total hip replacement and perioperative management. J South Orthop Assoc 11: 213–217

    PubMed  Google Scholar 

  16. Weeden SH, Paprosky WG, Bowling JW (2003) The early dislocation rate in primary total hip arthroplasty following the posterior approach with posterior soft-tissue repair. J Arthroplasty 18: 709–713

    Article  PubMed  Google Scholar 

  17. Wenz JF, Gurkan I, Jibodh SR (2002) Mini-incision total hip arthroplasty: a comparative assessment of perioperative outcomes. Orthopedics 25: 1031–1043

    PubMed  Google Scholar 

  18. Woolson ST, Mow CS, Syquia JF et al. (2004) Comparison of primary total hip replacement with a standard incision or a mini-incision. J Bone Joint Surg Am 86: 1353–1358

    PubMed  Google Scholar 

  19. Wright JM, Crockett HC, Delgado S et al. (2004) Mini-incision for total hip arthroplasty: a prospective, controlled investigation with 5-year follow-up evaluation. J Arthroplasty 19: 538–545

    Article  PubMed  Google Scholar 

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Affiliations

  1. Klinik für Orthopädische Chirurgie, Inselspital, Universität Bern, Bern, Schweiz

    M. Tannast

  2. Orthopedic Surgery, Center for Computer Assisted and Reconstructive Surgery, Tufts University School of Medicine, Harvard Medical School, New England Baptist Hospital, 125 Parker Hill Avenue Suite 545, USA-02120 , Boston, USA, MA

    S. B. Murphy & M. Tannast

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  1. S. B. Murphy
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  2. M. Tannast
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M. Tannast wurde unterstützt durch ein Stipendium des Schweizerischen Nationalfonds (SNF).

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Murphy, S.B., Tannast, M. Herkömmliche vs. minimal-invasive Hüftendoprothetik. Orthopäde 35, 761–768 (2006). https://doi.org/10.1007/s00132-006-0969-z

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  • DOI: https://doi.org/10.1007/s00132-006-0969-z

Schlüsselwörter

  • Totalhüftendoprothetik
  • Gewebeschonend
  • Mininal-invasiv
  • Rehabilitation
  • Komplikationen

Keywords

  • Total hip arthroplasty
  • Tissue-preserving
  • Minimally invasive
  • Recovery
  • Complications