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Published on: September 7, 2022
Experiences with the two incision minimal invasive hip replacement in 150 cases with a proximally hydroxyapatite
1Department of Orthopedic Surgery Martin Luther University Halle-Wittenberg, Halle, Germany. david.wohlrab@medizin.uni-halle.de
Background:
In this retrospective study we describe our experiences in minimally invasive two incision total hip replacement (THR).
Methods:
We performed 150 fluoroscopy-assisted two incision minimally invasive THR on 148 patients using a proximally coated hydroxyapatite implant. Clinical (Harris Hip Score (HHS), surgical time, blood loss, length of hospital stay) and radiographic data (leg length discrepancy, cup abduction angle, stem alignment) were collected.
Results:
The HHS increased from 54.7 preoperatively to 92.6 postoperatively. Mean surgical time was 103 minutes. Mean intra- operative blood loss was 410 ml. There were 11 (7.3%) complications including two dislocations (1.3%), one deep wound infection (0.7%), three minor calcar fractures (2.0 %), one periprosthetic femur fracture (0.7 %), two subsided stems (1.3%) and two femoral nerve palsies (1.3%). One of the femoral nerve palsies remained unresolved. The prevent femoral nerve palsies we used somato-sensory evoked potentials (SSEP) after the 48th case and there were no further nerve palsies. Ten complications were in the first 48 cases. In the first 28 cases the anterior skin incision was parallel to the femoral neck and then changed to parallel the intertrochanteric line. Mean length of stay was 2.2 days. Mean cup abduction angle was 39.4 degrees and mean cup anteversion was 34.6 degrees.
Conclusion:
The initial complication rate can be related to the learning curve using a new surgical technique. In the subsequent 102 surgeries there was one stem subsidence. The minimally invasive approach in THA remains new technique and carries additional risks. Secondary to the learning curve comparable short and long term follow up's are necessary.
Insights
This study evaluated minimally invasive two-incision total hip replacement (THR), showing improved patient outcomes and highlighting the importance of surgical experience for reducing complications.
Area of Science:
- Orthopedic Surgery
- Minimally Invasive Procedures
- Arthroplasty
Background:
- Retrospective analysis of minimally invasive two-incision total hip replacement (THR) techniques.
- Focus on surgeon experience and learning curve impact on outcomes.
Purpose of the Study:
- To describe experiences with minimally invasive two-incision total hip replacement (THR).
- To evaluate clinical and radiographic outcomes.
- To identify and address early complications.
Main Methods:
- 150 fluoroscopy-assisted, two-incision minimally invasive THR procedures performed on 148 patients.
- Use of proximally coated hydroxyapatite implants.
- Collection of clinical data (Harris Hip Score, surgical time, blood loss, hospital stay) and radiographic data (leg length discrepancy, cup/stem alignment).
Main Results:
- Significant improvement in Harris Hip Score (HHS) from 54.7 to 92.6.
- Mean surgical time: 103 minutes; mean blood loss: 410 ml.
- Initial complication rate of 7.3% (11/150), decreasing after implementing somato-sensory evoked potentials (SSEP) and modifying incision technique.
Conclusions:
- Initial complication rates in minimally invasive THR are linked to the learning curve.
- The technique, while promising, carries additional risks requiring careful management.
- Further comparable follow-up studies are necessary to validate long-term outcomes.