CURRENT STATE OF DOING MINIMAL INVASIVE TOTAL HIP REPLACEMENT IN GERMANY, IN-CLUDING THE USE OF NEW IMPLANTS AND THE NAVIGATION TECHNIQUE – RESULTS OF A NATIONWIDE SURVEY OF SURGICAL TRAUMA AND ORTHOPAEDIC CLINICS

Abstract

AIM: Total hip replacement is the most successful procedure since 3 decades. In the last years a lot of new helpful implants were introduced to the market, minimal invasive procedures are presented in increasing numbers and the technique of navigation is introduced. On the other hand there is no scientific proof of the benefit of these procedures. The objective of this study was to collect data about the different procedures and the common used implants.

METHOD: In a countrywide anonymous survey, 250 German trauma surgery and orthopaedic surgery departments were asked about their MIS procedures and their treatment strategies.(August 2006)

RESULTS: 112 of the questionnaires have been returned so far. We found 82% of the surgeons doing minimal invasive THR, 18% are doing more than 50% of all procedures in MIS technique, while 45% of the colleagues report, that the patients never ask for the procedure. Most of the surgeons (58%) define “minimal invasive” as the preservation of muscle, tendons and soft tissue, 1% as the preservation of bone and 41% as the length of skin incision (6–12cm). The most common MIS approach is the lateral (45%), followed by the anterior approach (25%) and the modified Watson-Jones approach (21%) and the MIS dorsal approach (19%) (Some use more than 1 approach). For standard procedure (not minimal invasive) there is most used the Kocher approach (51%), followed by Bauer approach (29%) and Smith-Petersen/Watson-Jones (19%). 23% use navigation and 51% are convinced, there is no sense in that.

• 66% do not use articular resurfacing, 33% are using short implants.

• 49% are using cellsaver regular, 99% are using wounddrains.

CONCLUSION: While the technique of MIS in THR is whidespread in Germany, an exact definition is still missing. Patients don’t expect MIS as much as surgeons perform it. Out of the variety of approaches a standard still has to be defined.

For minimal invasive procedure there is most used a lateral approach, for standard procedure the Kocher approach. New implants are used by every third surgeon, navigation by every fourth surgeon.