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Der minimal-invasive anteriore Zugang

Minimally invasive anterior approach

Der Orthopäde volume 41, pages 390–398 (2012)Cite this article

An Erratum to this article was published on 25 November 2012

Zusammenfassung

Der minimal-invasive anteriore Zugang für die Implantation einer Hüftprothese wurde 1985 erstmals publiziert. Seither wurde die Technik weiterentwickelt und die Indikationsstellung erweitert. Der Zugang nutzt die Muskellücke zwischen dem M. tensor fasciae latae lateral und dem M. sartorius medial. Diese Muskellücke ermöglicht einen direkten und schnellen Zugang zum Hüftgelenk unter Schonung der Muskulatur. Bei der Präparation des Femurs besteht jedoch die Gefahr der Schädigung des M. tensor fasciae latae. Ebenfalls gefährdet ist der N. cutaneus fermoris lateralis (NCFL), dessen Äste oder Hauptstamm beim Hautschnitt und bei der Dissektion des Subkutangewebes durchtrennt werden können. In diesem Artikel werden Technik, Risiken sowie die bisherigen klinischen Ergebnisse der Hüftprothesenimplantation über den minimal-invasiven anterioren Zugang dargestellt. Die Ergebnisse der Literatur seit 2005 und auch die eigenen Ergebnisse werden diskutiert. Bei der Durchsicht der Literatur wurde insbesondere auf die Inzidenz einer Läsion des NCFL, auf eine Muskelschädigung des M. tensor fasciae latae sowie auf die Positionierung der Hüftpfanne geachtet. Letztere ist aufgrund der geringeren Übersicht bei der minimal-invasiven Technik erschwert.

Abstract

The minimally invasive direct anterior approach for total hip arthroplasty (THA) was first published in 1985. Since then the technique has been further improved and the indications have been extended. The approach utilizes the muscle gap between the tensor fasciae latae muscle on the lateral side and the sartorius muscle on the medial side. This muscle gap allows a direct and quick approach to the hip joint with good muscle preservation. During preparation of the femur the tensor fasciae latae muscle is at risk of being damaged. The lateral cutaneous nerve of the thigh (NCFL) and its branches are also in danger of being damaged during skin incision and dissection of the subcutaneous tissue. In this article the technique, risks and current clinical results of THA using the minimally invasive direct anterior approach are described. The results from the literature, as well as own results are compared to the traditional transgluteal lateral Bauer approach and discussed. Reviewing the literature, special attention has been given to the incidence of NCFL lesions, damage of the tensor fasciae latae muscle and positioning of the cup. Especially for the latter, the general view is hindered in the minimally invasive technique.

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Affiliations

  1. Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität Würzburg, Brettreichstr. 11, 97074, Würzburg, Deutschland

    U. Nöth MHBA, A. Nedopil, B.M. Holzapfel, M. Koppmair, S. Goebel, J. Eulert & M. Rudert

  2. Klinik für Orthopädie und Unfallchirurgie, Franziskus-Hospital Harderberg, Harderberg, Deutschland

    O. Rolf

Authors
  1. U. Nöth MHBA
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  2. A. Nedopil
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  3. B.M. Holzapfel
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  4. M. Koppmair
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  5. O. Rolf
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  6. S. Goebel
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  7. J. Eulert
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  8. M. Rudert
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Correspondence to U. Nöth MHBA.

Additional information

An erratum to this article can be found online at http://dx.doi.org/10.1007/s00132-012-2030-8

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Nöth, U., Nedopil, A., Holzapfel, B. et al. Der minimal-invasive anteriore Zugang. Orthopäde 41, 390–398 (2012). https://doi.org/10.1007/s00132-011-1894-3

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  • DOI: https://doi.org/10.1007/s00132-011-1894-3

Schlüsselwörter

  • Hüftprothese
  • Minimal-invasiv
  • Vorderer Zugang
  • Nervenschaden
  • Muskelschaden

Keywords

  • Total hip arthroplasty
  • Minimally invasive
  • Direct anterior approach
  • Muscle damage
  • Nerve lesion