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Minimalinvasive Operationstechniken in der Hüftgelenktotalendoprothetik

Operationstechniken der Zukunft?

Minimally invasive surgery in total hip arthroplasty

Surgical technique of the future?

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Zusammenfassung

Studienziel

Es wurde eine selektive Literaturanalyse der aktuellen Datenlage klinisch prospektiv kontrollierter Studien über den Vergleich minimalinvasiver Hüftendoprothetik (MIS) gegenüber der Standardtechnik durchgeführt.

Methode

Eine Onlinedatenbankrecherche wurde erhoben mit Vergleich der MIS und dem Standardvorgehen innerhalb der letzten 3 Jahre (2009 bis 2011). Daten wie Operationsdauer, Blutverlust, Harris Hip Score und Komplikationen sowie Implantatpositionierungen wurden gesondert betrachtet und verglichen.

Ergebnisse

In 11 Studien wurden 387 minimalinvasiv operierte Hüften mit 264 Standardoperationen verglichen. In der Mehrzahl der Studien wurde im Gruppenvergleich über postoperativ signifikant erniedrigte Werte für die Messkonzentrationen von Kreatinkinase und/oder des Myoglobinlevels und einem verringerten intraoperativen Blutverlust berichtet. Im früheren postoperativen Verlauf (bis zur 6. postoperativen Woche) zeigten sich in der MIS-Gruppe Vorteile im klinischen Harris Hip Score. Bezüglich der Komplikationen, insbesondere der Implantatpositionierung, ergaben sich keine statistisch signifikanten Unterschiede. Die Operationszeit war in der MIS-Gruppe in einzelnen Studien signifikant länger.

Schlussfolgerung

Minimalinvasive Techniken in der primären Hüftendoprothetik werden mittlerweile weniger als nur kosmetisch attraktiv und eher als echte Verbesserung für das klinische Ergebnis angesehen. Prospektive klinisch kontrollierte Studien der letzten 3 Jahre ergeben diesbezüglich übereinstimmende Vorteile im frühen postoperativen Verlauf.

Abstract

Aim

A selective analysis of the latest literature was carried out including prospective clinical controlled studies on the comparison between minimally invasive total hip arthroplasty (MIS) and the conventional technique.

Methods

An online data base search for controlled study designs within the last 3 years (2009–2011) which compared MIS with standard procedures was performed. Data such as operation time, blood loss, Harris hip score, complications and implant positioning were compared.

Results

A total of 11 studies which compared the results of 387 MISs and 264 operations on hips with the standard technique were analyzed. In the majority of the studies reduced levels of creatine kinase and myoglobin as well as reduced intraoperative blood loss were reported. In the early postoperative period up to postoperative week 6 significant advantages in the Harris hip score were reported for the MIS patients. Postoperative complications and implant positioning were comparable in both groups. The operation time was significantly longer in the MIS group for some studies.

Conclusions

Minimally invasive techniques in total hip arthroplasty are nowadays no longer seen as just cosmetically attractive but rather as a real improvement for the clinical outcome. In this respect prospective clinically controlled studies within the last 3 years showed advantages in the early postoperative period.

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Authors and Affiliations

  1. Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland

    M. Wörner, M. Weber, P. Lechler, E. Sendtner, J. Grifka & T. Renkawitz

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  1. M. Wörner
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  2. M. Weber
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  3. P. Lechler
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  4. E. Sendtner
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  5. J. Grifka
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  6. T. Renkawitz
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Correspondence to M. Wörner.

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Wörner, M., Weber, M., Lechler, P. et al. Minimalinvasive Operationstechniken in der Hüftgelenktotalendoprothetik. Orthopäde 40, 1068–1074 (2011). https://doi.org/10.1007/s00132-011-1846-y

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