Minimally invasive surgery in total hip arthroplasty
Journal Title: Ortopedia Traumatologia Rehabilitacja - Year 2007, Vol 9, Issue 1
Abstract
The success of orthopedic surgery depends on quick recovery of limb function. Every injury to a muscle or its attachment is associated with decreased muscle strength and disturbed proprioception, impeding recovery. Minimally Invasive Surgery (MIS) is performed through a short skin incision, avoiding injury to muscles and tendons. In Total Hip Arthroplasty (THA) the advantages of MIS over classic techniques include faster recovery, shorter rehabilitation and hospitalization time, decreased blood loss, less pain and less scarring. The anterior approach to the hip, described by Robert Jones in 1947 as a modified Smith-Petersen approach, follows the principles of MIS. Other approaches promoted as minimally invasive (posterior, lateral, or double incision) are associated with muscle and/or tendon injury, and should thus be referred to as Less Invasive Surgery (LIS). Complications in THA operations using MIS occur most often in women affected by osteoporosis, older than 65, or with a BMI of more than 32. The rate of complications doubles with surgeons who perform less than 50 THAs per year. A special set of instruments facilitates implantation of the endoprosthesis and reduces the number of complications. The anterior approach allows for endoprosthesis implantation without damage to muscles and muscle insertions, reduces tissue damage, and, more importantly, decreases postoperative pain. Should complications occur, the anterior approach has the advantage of simple access to the proximal femur by extending the approach distally, as in the Smith-Petersen technique. However, the technical challenges of MIS and the risk of complications dictate caution.
Authors and Affiliations
Piotr Wojciechowski, Damian , Konrad Kopeć, Marcin Borowski
Keywords
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