Operative Orthopadie und Traumatologie · 2017
One-stage bilateral implantation of a calcar-guided short-stem in total hip arthroplasty : Minimally invasive modified anterolateral approach in supine position.
СтатьяОбзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Kutzner K P, Donner S, Schneider M, Pfeil J, Rehbein P
Аннотация
OBJECTIVE: One-stage bilateral, muscle-preserving, calcar-guided implantation technique through the modified minimally invasive anterolateral approach in supine position.
INDICATIONS: Bilateral primary/secondary osteoarthritis of the hip; bilateral femoral head necrosis; ASA I-III.
CONTRAINDICATIONS: ASA IV; severe osteoporosis, other factors jeopardizing stable anchorage of cementless, calcar-guided short-stem; infection.
SURGICAL TECHNIQUE: Supine position. Skin incision. Opening of fascia; blunt dissection, pushing gluteal muscles dorsally with the index finger. Capsulectomy. Individual osteotomy according to preoperative plan to determine short-stem position. Remove femoral head. Prepare acetabulum. Position cup. Femoral preparation with the curved opening awl. Spare greater trochanter and gluteal muscles. Insert trial rasps in ascending sizes with "round-the-corner" technique. Select offset version, then trial reposition with intraoperative radiograph and implantation of the definitive implant. Wound closure. Consultation with the anesthesiologist to confirm a stable patient. Same procedure on contralateral hip.
POSTOPERATIVE MANAGEMENT: Mobilization on day 1 with immediate full weight bearing. Remove wound drains and urinary catheter (only female patients) on day 2. Intensive protocol of physiotherapy and rehabilitation. Thrombosis prophylaxis. Rehabilitation from day 7.
RESULTS: Almost 500 patients have undergone surgery since 2010. First consecutive 54 patients (108 hips) prospectively evaluated. After 2 years, Harris Hip Score was 98.8; satisfaction on visual analogue scale was 9.9. Low peri- and postoperative complication rates; no implant revisions.
CONCLUSION: The muscle-sparing approach and the special "round-the-corner" technique in one-stage bilateral procedure leads to rapid mobilization and rehabilitation with excellent early clinical results and high satisfaction rates.
INDICATIONS: Bilateral primary/secondary osteoarthritis of the hip; bilateral femoral head necrosis; ASA I-III.
CONTRAINDICATIONS: ASA IV; severe osteoporosis, other factors jeopardizing stable anchorage of cementless, calcar-guided short-stem; infection.
SURGICAL TECHNIQUE: Supine position. Skin incision. Opening of fascia; blunt dissection, pushing gluteal muscles dorsally with the index finger. Capsulectomy. Individual osteotomy according to preoperative plan to determine short-stem position. Remove femoral head. Prepare acetabulum. Position cup. Femoral preparation with the curved opening awl. Spare greater trochanter and gluteal muscles. Insert trial rasps in ascending sizes with "round-the-corner" technique. Select offset version, then trial reposition with intraoperative radiograph and implantation of the definitive implant. Wound closure. Consultation with the anesthesiologist to confirm a stable patient. Same procedure on contralateral hip.
POSTOPERATIVE MANAGEMENT: Mobilization on day 1 with immediate full weight bearing. Remove wound drains and urinary catheter (only female patients) on day 2. Intensive protocol of physiotherapy and rehabilitation. Thrombosis prophylaxis. Rehabilitation from day 7.
RESULTS: Almost 500 patients have undergone surgery since 2010. First consecutive 54 patients (108 hips) prospectively evaluated. After 2 years, Harris Hip Score was 98.8; satisfaction on visual analogue scale was 9.9. Low peri- and postoperative complication rates; no implant revisions.
CONCLUSION: The muscle-sparing approach and the special "round-the-corner" technique in one-stage bilateral procedure leads to rapid mobilization and rehabilitation with excellent early clinical results and high satisfaction rates.