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Minimal-invasive Hüftendoprothetik über einen direkten vorderen Zugang

Minimally invasive total hip arthroplasty via direct anterior approach

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Zusammenfassung

Hintergrund

Minimal-invasive Hüftendoprothetik will durch Verminderung des Gewebeschadens die postoperative Wiederherstellung beschleunigen. Der vordere Zugang verspricht optimale Weichteilschonung.

Patienten und Methode

Sicherheit und Machbarkeit der minimal-invasiven Hüftendoprothetik über einen vorderen Zugang ohne Extensionstisch wurde in einer prospektiven Kohortenstudie an 100 konsekutiven Patienten getestet. Keine Ausschlusskriterien, zementierte und zementfreie Implantationstechnik.

Ergebnisse

Es gab keine 2. Inzision, keine Nervenlähmungen und keine Luxationen. Der Pfanneninklinationswinkel betrug median 44,1°, die Schaftstellung median 0° Varus/Valgus. Die Technik zeigt kurze, zufrieden stellende Narben, geringen Blutverlust, geringe postoperative Schmerzen, eine beschleunigte Rehabilitation und frühe Krankenhausentlassung. 6 Patienten zeigten einen bleibenden Schaden des N. cutaneus femoris lateralis.

Schlussfolgerung

Die vorgestellte Technik ist sicher, sie erlaubt eine korrekte Pfannen- und Schaftpositionierung. Sie lässt sich in angemessener Zeit durchführen, der Blutverlust ist gering.

Abstract

Background

Minimally invasive total hip arthroplasty (THA) aims at reduction of tissue damage to accelerate recovery. The anterior approach promises optimal soft tissue preservation.

Patients and method

Safety and feasibility of minimally invasive THA via an anterior approach without the use of an orthopedic table was tested in a prospective cohort study on 100 consecutive patients. There were no exclusion criteria, and cementless and cemented techniques were employed.

Results

No second incision was needed and neither nerve palsy nor dislocation was observed. The inclination angle of the cup was a median of 44.1° and the position of the stem a median of 0° varus/valgus. Short, satisfactory scars, little blood loss and postoperative pain, accelerated rehabilitation, and early discharge were noted. There were six cases of a permanent lesion of the lateral femoral cutaneous nerve.

Conclusion

The proposed technique is safe and allows correct positioning of the cup and stem. It can be performed in a reasonable amount of time and blood loss is little.

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Danksagung

Herr Dr. Eckhart Mayr hat die Patientendaten gewartet und sich an der Auswertung beteiligt.

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Authors and Affiliations

  1. Klinik für Orthopädie, Medizinische Universität, Innsbruck

    F. Rachbauer

  2. Klinik für Orthopädie, Medizinische Universität, Anichstraße 35, A-6020, Innsbruck, Österreich

    F. Rachbauer

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  1. F. Rachbauer
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Correspondence to F. Rachbauer.

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Rachbauer, F. Minimal-invasive Hüftendoprothetik über einen direkten vorderen Zugang. Orthopäde 34, 1103–1111 (2005). https://doi.org/10.1007/s00132-005-0854-1

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