Background: Adjuvant radiotherapy has shown to improve local control in patients with soft tissue sarcoma. Additional brachytherapy represents a means of enhancing the therapeutic ratio, as biological and dosimetric advantage over single external-beam irradiation (EBRT) can be expected. High-dose-rate intraoperative brachytherapy (IOHDR) as a boost therapy should be able to further diminish the rate of local recurrence even when performing marginal resection.

Patients and Methods: Within a period of 10 years, we prospectively studied 84 adult patients treated by marginal resection, IOHDR using the flab technique and EBRT for soft tissue sarcomas. There were 67 high-grade and 17 low-grade tumors, 70 were > 5 cm. Mean follow-up was 37.2 months (range 1–121 months).

Results: There were two local recurrences, following further resection one patient is without evidence of tumor. No treatment-related loss of limb or life occurred. All patients maintained functioning extremities as evidenced by a mean Musculoskeletal Tumor Society (MSTS) functional score of 89.1 (43–100). Treatment-related wound morbidity occurred in a fifth of all patients, as consequence of revision surgery one patient sustained neurovascular complications. The 5-year actuarial disease-free survival was 81.6%. Meta-static disease developed in eighteen patients, all of them had died at last follow-up. There were four cases of late radiation related complications (two fractures of the femur due to radiation osteonecrosis and two late palsies of ischial nerve).

Conclusions: IOHDR using the flab technique in combination with EBRT and marginal resection is an efficient treatment technique leading to excellent local control rates and limited functional impairment.

Introduction: Minimally invasive total hip arthroplasty has evoked substantial controversy with regard to whether it provides superior outcomes compared with conventional total hip arthroplasty. The objective of this study was to compare the results of a minimal invasive direct anterior approach (MIDA) with those of a conventional lateral transgluteal approach (CLT).

Methods: 120 patients (120 hips) admitted for unilateral total hip arthroplasty were randomized to undergo surgery via minimal invasive direct anterior or conventional lateral transgluteal approach. Patients with a body mass index of more than 35, previous hip surgery, preoperative neurological deficits and with an age of more than 80 years were excluded. Two surgeons performed all procedures. To estimate muscle damage serum creatinkinase was assessed. Blood loss was calculated according to Rosencher by comparing preoperative to postoperative hematocrit. Postoperative pain and the ability to perform the activities of daily living were recorded in a dairy via modified WOMAC first on a daily basis, then on each second day and finally once a week for a total of 12 weeks. WOMAC questionnaire and SF-36 were administered at 6 weeks and 3 months follow-up.

Results: The groups were similar demographically. Patients in MIDA group had significantly less total blood loss (p = 0.006), postoperative blood levels of creatinine kinase were significantly lower (p = 0.001). Operative time was similar in both groups, we found no difference in component placement. Physical component summary of SF-36 at 12 weeks follow-up showed a significant benefit for the MIDA group. Averaged modified WOMAC scores and their pain and function subscores demonstrated a clear advantage on every recorded day during the first 12 weeks for MIDA. Median WOMAC sum score and respective pain as well as function subscores were better in the MIDA group at 6 and 12 weeks follow up.

Conclusions: A minimally invasive direct anterior approach is superior to a conventional lateral transgluteal approach with regard to blood loss and muscle trauma, resulting in better health related quality of life in the first three months after operation.

Introduction: In a prospective clinical study the feasibility of total hip arthroplasty via a minimal invasive single incision anterior approach was analyzed. 100 consecutive patients with no exclusion criteria (52 females, 48 males, mean age 65.6 yrs) were included. 19 patients showed a BMI > 30.

Material and Methods: The patients were placed in a supine position on the OR table. After skin incision the interval between sartorius, tensor fasciae latae, rectus femoris and glutaeus medius/minimus was split to bluntly expose the anterior aspect of the hip joint capsule. No muscle had to be dissected. Following capsular incision the neck was osteotomized in-situ. After reaming a cemented or cement-less cup was inserted. The calcar was elevated with a hook to the level of skin incision. By placing special two-pronged retractor between the inserting abductor tendons and the greater trochanter the broaching of the femoral medullar canal could be easily performed. Followed by implanting a cemented or cement less stem.

Results: The median incision length was 6.75 cm. Median angle of cup inclination was 44.1 and 0 of varus/ valgus position for the stem. Blood loss was significantly reduced. The rehabilitation was fast (mean WOMAC score 90.4 at 6 weeks) and patients showed only little postoperative pain. No dislocations or nerve palsies occurred. The complication rate was low with one fissure of the proximal femur, one perforation of the acetabulum and one deep infection.

Conclusion: The study demonstrated that blood loss, postoperative pain and hospitalization time were reduced with a correct placement of the implants. The rehabilitation was quicker. Therefore we state that the minimal invasive anterior approach is safe and lead to advantages for the patients.

Objective: To compare the cup and stem position in matched pairs of cadaveric hips performing a minimally invaisve total hip arthroplasty (MIS-THA) either by using manual guidance tools or by the STRYKER Hip-track Navigation System.

Background: Minimally invasive techniques are currently introduced to THA. Our workgroup has developed a direct anterior single incission approach. Special instruments have been designed for retraction and implantation. Instruments are navigable with the STRYKER hiptracksystem. Perfect positioning of the acetabular and femoral component are among the most important factors in THA. Malpositioning may result in significant clinical problems such as dislocation, impingement, limited range of motion or extensive wear.

Design/Methods: In twelve fixated human cadavers hemispherical pressfit cups (TRIDENT, Stryker, Alledale, NJ) and straight femoral components (ACCOLADE, Stryker, Allendale, NJ) were implanted. All implantation were done throught the minimally invasive direct anterior approach. On one side the surgery was performed with spezial MIS instruments. On the oposite side the navigation system was used for placement of the implants. The aim was to achieve an alignment for the cups with 45° of inclination and 15° of anteversion in reference to the frontal pelvic plane. For the stem the goal was to position the stem in 0° of varus/valgus relative to the proximal shaft axes. This plane and the resulting cup positions were measured on CT-scans with a 3D imaging software (Stryker-Leibinger, Freiburg, Germany).

Results: The Innsbruck MIS approach to the hip could be performed in all cases. For both groups cup and stem position where within the range of variation reported in the literature. Yet, variance of the deviation from the goal was higher in the conventional group for both inclination and anteversion with the medians for the navigated group for inclination, anteversion and stem position being closer to the goal then in the conventional group.

Conclusion: The described minimally invasive approach to the hip is feasible and renders results compareable to those reported for conventionally operated THA. By the use of the navigation system tested it is possible to increase placement precission

Malposition of the acetabular component is a risk factor for post-operative dislocation after total hip replacement (THR). We have investigated the influence of the orientation of the acetabular component on the probability of dislocation. Radiological anteversion and abduction of the component of 127 hips which dislocated post-operatively were measured by Einzel-Bild-Röentgen-Analysis and compared with those in a control group of 342 patients.

In the control group, the mean value of anteversion was 15° and of abduction 44°. Patients with anterior dislocation after primary THR showed significant differences in the mean angle of anteversion (17°), and abduction (48°) as did patients with posterior dislocation (anteversion 11°, abduction 42°). After revision patients with posterior dislocation showed significant differences in anteversion (12°) and abduction (40°).

Our results demonstrate the importance of accurate positioning of the acetabular component in order to reduce the frequency of subsequent dislocations. Radiological anteversion of 15° and abduction of 45° are the lowest at-risk values for dislocation.