Abstract
In recent years advances in operative techniques have allowed surgeons to perform total hip arthroplasty (THA) through incisions much smaller than those used previously. Potential advantages of these techniques include the reduction of blood loss and pain in the immediate postoperative period and preserving muscle function.
Potential disadvantages might include increased wound infection rate due to skin ischemia, intraoperative neurovascular injuries, and component malposition. This in turn may lead to long term complications, such as instability, osteolysis, and loosening.
The purpose of this study is to present our results with total hip arthroplasty performed through a minimal invasive technique which is a modification of the standard posterolateral approach.
Methods: In this retrospective study 91 consecutive patients underwent primary total hip arthroplasties were reviewed. The surgeries were performed at our institution from January 2001 to December 2003.
Surgical indications included primary osteoarthritis, subcapital fractures, malignancy, hip displasia, Otopelvis, rheumatoid arthritis and AVN. Exclusion criteria included revision hip arthroplasty, and cemented operations.
A modification of the standard posterlateral approach was used. Standard hip arthroplasty instruments along with curved acetabular reamers and impactor were used. Incision extent was determined by the size of the acetabular component. A fully Hidroxyapetite coated stem, and porous coated acetabullar component were used. Immediate full weight bearing postoperative regimen was allowed in all cases.
Results: In 17 patients (group A) the indication for surgery was a recent subcapital fracture. 74 patients (group B) had no trauma. The average age was 64.2 in group A and 65.1 in group B. No case of deep infection was documented in either group. 5 patients in group B had a single event of a posterior dislocation that was treated successfully with closed reduction. No dislocation occurred in group A. 35% (4) of group A and 41% (22) of group B did not require postoperative blood transfusions. 47% (6) and 36% (14) respectively needed transfusion of 3 blood units or more. Average hospitalization time was 6 days. None of the patients in both groups needed re-operation.
Conclusions: Minimally invasive total hip arthroplasty is associated with a short hospitalization period and relatively low rate of blood transfusion. No major wound healing problems were documented in our series. It appears that the relatively high dislocation rate might be explained partly due to the common use of ceramic inserts. Further modification of the technique for proper acetabular component orientation is needed. However, more prospective with longer follow-up research must be conducted before definitive recommendations can be made.
The abstracts were prepared by Ms Orah Naor. Correspondence should be addressed to Israel Orthopaedic Association at PO Box 7845, Haifa 31074, Israel.
