M Rittmeister1, A Peters. 1. Orthopädische Universitätsklinik, Friedrichsheim, Frankfurt am Main. m.rittmeister@friedrichsheim.de
Abstract
AIM: A refinement of the classic surgical approaches to the hip for total hip arthroplasty (THA) is presently being developed with a drastic shortening of the skin incision. The aim of this study was to explore if a minimal-invasive posterior approach (1) is technically feasible regardless of varying patient anatomy and (2) is associated with such results that do not suggest increased patient risk. We sought to find out how surgical time, blood loss, requirement for pain medication, pain perception and implant position were affected by a posterior mini-incision approach for THA. METHODS: Prospectively, the results of 76 consecutive THAs operated by the same surgeon via a posterior mini-incision approach were recorded. RESULTS: The length of skin incision ranged from 6.0 to 11.0 cm. On average, surgical time was 83 minutes, intraoperative blood loss was 343 ml, and the amount of PCA-administered Piritramid i. v. in the first 24 hours was 21.4 mg. Pain-free (defined as a 0-10 self rating on a VAS) were 8 % of the patients on day one following mini-incision THA, 41 % on day three, 54 % on day five and 71 % of patients on day seven. The average cup inclination and anteversion were 46 and 13 degrees, stem position was regarded as neutral in 76 %. Complications occurred in 7 patients (9 %). CONCLUSION: Our posterior mini-incision approach allowed for the placement of 76 consecutive THAs through a skin incision of equal to or less than 11.0 cm in a non-selected population without jeopardising patient safety.
AIM: A refinement of the classic surgical approaches to the hip for total hip arthroplasty (THA) is presently being developed with a drastic shortening of the skin incision. The aim of this study was to explore if a minimal-invasive posterior approach (1) is technically feasible regardless of varying patient anatomy and (2) is associated with such results that do not suggest increased patient risk. We sought to find out how surgical time, blood loss, requirement for pain medication, pain perception and implant position were affected by a posterior mini-incision approach for THA. METHODS: Prospectively, the results of 76 consecutive THAs operated by the same surgeon via a posterior mini-incision approach were recorded. RESULTS: The length of skin incision ranged from 6.0 to 11.0 cm. On average, surgical time was 83 minutes, intraoperative blood loss was 343 ml, and the amount of PCA-administered Piritramid i. v. in the first 24 hours was 21.4 mg. Pain-free (defined as a 0-10 self rating on a VAS) were 8 % of the patients on day one following mini-incision THA, 41 % on day three, 54 % on day five and 71 % of patients on day seven. The average cup inclination and anteversion were 46 and 13 degrees, stem position was regarded as neutral in 76 %. Complications occurred in 7 patients (9 %). CONCLUSION: Our posterior mini-incision approach allowed for the placement of 76 consecutive THAs through a skin incision of equal to or less than 11.0 cm in a non-selected population without jeopardising patient safety.