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Komplikationen nach minimal-invasiver Hüftendoprothetik

Complications after minimally invasive total hip arthroplasty

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Zusammenfassung

Hintergrund

Ziel minimal-invasiver Zugänge in der Hüftendoprothetik ist die Verringerung des Operationstraumas ohne Einschränkungen der Exposition von Femur und Azetabulum zur Gewährleistung einer reproduzierbaren Implantation. Trotz zunehmend verbesserter Instrumentation ist die Etablierung dieses Vorgehens in der Lernphase mit dem Risiko einer erhöhten Komplikationsrate verbunden.

Ziel der Arbeit

Die vorliegende Arbeit stellt spezifische und unspezifische Komplikationen nach minimal-invasiver Implantation einer Hüfttotalendoprothese (HTEP) dar und beschreibt Hinweise zu deren Vermeidung.

Material und Methoden

Es handelt sich um ein retrospektives Studiendesign. Bei 152 Revisionsoperationen nach minimal-invasiver HTEP-Implantation wurden eine Nachuntersuchung und eine Fehleranalyse durchgeführt.

Ergebnisse

Von den Patienten der 152 Revisionsoperationen waren 87 weiblich und 65 männlich. Eine genderspezifische Komplikationshäufigkeit konnte nicht festgestellt werden. Die häufigste Indikation zur Wechseloperation wurde aufgrund rezidivierender Luxationen gestellt. Nach anterolateralem Zugang in Rückenlage ergab sich eine größere Häufigkeit von Frakturen des Trochanter major.

Diskussion

Die minimal-invasive Implantation führt nur bei korrekter Technik zu sehr guten Ergebnissen. Vom muskelschonenden Aspekt des minimal-invasiven Zugangs profitieren besonders junge Patienten. Dieses Patientenkollektiv hat ein hohes Risiko, einem Revisionseingriff unterzogen werden zu müssen.

Abstract

Background

The goal of minimally invasive surgery in total hip arthroplasty (MIS-THA) is reduction of surgical trauma without any limitations regarding exposure of the femur and acetabulum to achieve reproducible results. Despite improved instrumentation the implementation of these techniques is associated with a risk of higher complication rates.

Aim

The article describes specific and unspecific complications of MIS-THA and gives hints and tips on how to avoid them.

Material and methods

In a retrospective study 152 THA revisions following MIS-THA were examined and an error analysis was performed.

Results

The study of 152 MIS-THA revisions included 87 female and 65 male patients. A gender-specific incidence of complications could not be found. The most common indication for revision surgery was due to recurrent dislocation. An increased incidence of fractures of the greater trochanter was observed using the anterolateral approach with the patient in a supine position.

Discussion

The MIS-THA procedure contributes to excellent early rehabilitation when performed correctly. The muscle preserving aspect can be counted as an advantage particularly for young patients. This patient collective has a high risk to undergo revision surgery.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. R. Hube, M. Dienst, P. von Roth geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. OCM-Klinik GmbH, Steiner Str. 6, 81369, München, Deutschland

    R. Hube & M. Dienst

  2. Centrum für Muskuloskeletale Chirurgie, Klinik für Orthopädie, Charité-Universitätsmedizin Berlin, Berlin, Deutschland

    P. von Roth

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  1. R. Hube
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  2. M. Dienst
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  3. P. von Roth
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Correspondence to R. Hube.

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Hube, R., Dienst, M. & von Roth, P. Komplikationen nach minimal-invasiver Hüftendoprothetik. Orthopäde 43, 47–53 (2014). https://doi.org/10.1007/s00132-013-2123-z

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  • DOI: https://doi.org/10.1007/s00132-013-2123-z

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