Experiences with the two incision minimal invasive hip replacement in 150 cases with a proximally hydroxyapatite coated implant.
BACKGROUND
In this retrospective study we describe our experiences in minimally invasive two incision total hip replacement (THR).


METHODS
We performed 150 fluoroscopy-assisted two incision minimally invasive THR on 148 patients using a proximally coated hydroxyapatite implant. Clinical (Harris Hip Score (HHS), surgical time, blood loss, length of hospital stay) and radiographic data (leg length discrepancy, cup abduction angle, stem alignment) were collected.


RESULTS
The HHS increased from 54.7 preoperatively to 92.6 postoperatively. Mean surgical time was 103 minutes. Mean intra- operative blood loss was 410 ml. There were 11 (7.3%) complications including two dislocations (1.3%), one deep wound infection (0.7%), three minor calcar fractures (2.0 %), one periprosthetic femur fracture (0.7 %), two subsided stems (1.3%) and two femoral nerve palsies (1.3%). One of the femoral nerve palsies remained unresolved. The prevent femoral nerve palsies we used somato-sensory evoked potentials (SSEP) after the 48th case and there were no further nerve palsies. Ten complications were in the first 48 cases. In the first 28 cases the anterior skin incision was parallel to the femoral neck and then changed to parallel the intertrochanteric line. Mean length of stay was 2.2 days. Mean cup abduction angle was 39.4 degrees and mean cup anteversion was 34.6 degrees.


CONCLUSIONS
The initial complication rate can be related to the learning curve using a new surgical technique. In the subsequent 102 surgeries there was one stem subsidence. The minimally invasive approach in THA remains new technique and carries additional risks. Secondary to the learning curve comparable short and long term follow up's are necessary.
Wohlrab
David
D
Department of Orthopedic Surgery Martin Luther University Halle-Wittenberg, Halle, Germany. david.wohlrab@medizin.uni-halle.de
Sotereanos
N
N
D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D020099:Coated Materials, Biocompatible; D017886:Durapatite; D005260:Female; D005471:Fluoroscopy; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D015641:Radiography, Interventional
D020099:Coated Materials, Biocompatible; D017886:Durapatite