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Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 514 - 514
1 Sep 2012
Farag M Ghanem M Prietzel T Von Salis-soglio G
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Aim

In the last years, many short hip stem variants were developed, almost always sharing the principle of metaphyseal and proximal diaphyseal anchorage. In this study, we analyzed the midterm results after implanting short cementless hip stem of ESKA.

Methods

A total of 380 total hip replacements using the ESKA-short cementless stems were performed in a series of 340 patients between November 2002 till May 2008. The clinical and radiological evaluation of the patients was done in September 2008. The mean follow up was 37 months (3–54 months).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 407 - 407
1 Sep 2012
Prietzel T Farag M Petermann M Pretzsch M Heyde C
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Aim

Our goals were to minimize the invasiveness of the revision hip arthroplasty approach in order to accelerate the patient's rehabilitation, shorten the length of hospitalization and reduce the postoperative complications, especially the rate of joint dislocation. Our study aimed to prove whether and under which conditions the less invasive approach is preferable in revision arthroplasty.

Material and Methods

The modified revision technique differs from the conventional approach in the following main aspects:

Oncologic: applying larger hip balls and inserts, after expanding the variety of the available articulating joint components in 4 mm steps (28–40 mm),

sparing and reconstructing the joint capsule, whereby the integrity of its acetabular origin is crucial.

That procedure was combined with tissue dissection strictly parallel to the direction of the muscle fibers. The transgluteal approach after Bauer was applied. The small skin incision was closed by running subcuticular technique. The inpatient postoperative phase after revision total hip arthroplasty was evaluated in the last 6.5 years. All patients completed a questionnaire.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 156 - 156
1 May 2011
Prietzel T Farag M Petermann M Von Salis-Soglio G
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Aim: Our aim was to reduce the invasiveness of the THA approach in both primary and revision operations, in order to reach a better functional outcome, to facilitate patient’s rehabilitation and to minimize the encountered operation risks such as dislocation. To achieve our goal, we modified the conventional surgical technique by sparing and reconstructing the joint capsule as well as implanting an individually adapted hip ball size.

Material and Methods: The LI-THA differs from the conventional THA in the following aspects:

Selecting the most appropriate size of hip ball among a different variety ranging from 28–44 mm in diameter, in order to simulate the size of the resected femur head and increase the joint stability as much as possible.

Sparing and completely reconstructing the joint capsule, especially its acetabular origin.

Muscular and iliotibial tract incisions are made parallel to the direction of fibres in order to facilitate optimal surgical reconstruction.

Small skin incision together with using absorbable subcuticular skin closure technique to reduce postoperative wound complications.

1004 cases of primary THA and 36 cases of THA revision were evaluated after applying the less invasive technique. A questionnaire was designed to evaluate the patient’s satisfaction regarding pain and function, necessary reoperations, complications such as dislocation or wound dehiscence and leg length discrepancy. Additionally, Symptoms and function were assessed by WOMAC Osteoarthritis Index.

Results: 1004 LI-THA and 36 LI-THA revisions were performed over a period of 82 months. 2 cases of early infection and 2 cases of postoperative haematomas needed surgical intervention. One of the two recorded dislocations was a result of excessive sinking of the endoprosthetic stem. Both of which were successfully surgically corrected. The length of stay was 3 days shorter in comparison to the conventional technique.

Conclusion: The LI-THA is a modified conventional method associated with a low complication rate, which can be used in almost all cases of primary THA and most cases of THA revision. Sparing and reconstruction of the joint capsule as well as implanting the largest possible hip ball chosen from different sizes – ranging from 28 to 44 mm – are the most important modifications, which improve the joint stability and indirectly aid the exact reconstruction of leg length. Based on its low complication rate and short length of stay, the LI-THA is both medically and economically recommended.