Vergleichende klinische Ergebnisse nach Hüfttotalendoprothesenimplantation über den minimalinvasiven anterioren Zugang gegenüber dem lateralen Standardzugang nach Bauer- Eine prospektive Untersuchung -
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Philipps-Universität Marburg
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Background: Total hip arthroplasty in degenerative joint disease of the hip joint have been done for many decades and there are continually efforts to improve surgical approaches and implants.
Aim of the study: The aim was to identify the advantages and disadvantages of the minimally invasive anterior approach compared to the slightly modified standard Bauer approach, with particular consideration of rehabilitation, in order to provide decision-making aids for patients and / or surgeons.
Material and methods: In this prospective study, 45 vs. 47 patients were treated with one of the two surgical methods, examined and interviewed at the time points pre-op, post-op, after rehabilitation, after 3 and 6 months.
The Harris Hip Score, an ICF-based survey, clinical examinations, physiotherapeutically documented postoperative mobilization progress, radiological and laboratory parameters were used for this purpose.
Rehabilitation management by the payers, the setting of rehabilitation and patient satisfaction were also examined.
Results: There were no significant differences between the groups in terms of blood loss, type of anchoring and duration of surgery. The offset of the prosthesis and the radiologically determined leg length difference also showed no significant differences.
Postoperative mobilization progress was significantly faster in the anterior minimally invasive surgery group than in the control group for all tested parameters, and the average length of hospital stay was one day shorter.
At the 6-month follow-up, minimally invasive surgery patients also showed significantly better mobility of the hip joint in extension, flexion and abduction, as well as when climbing stairs. The patients who underwent minimally invasive surgery tended to have fewer restrictions during sleep, bending, walking, sitting and housework.
With regard to complications, the access route in the group of patients who underwent minimally invasive surgery suffered sensory disturbances in the area supplied by the lateral femoral cutaneous nerve after 6 months, from which 4 patients named it as disturbing in everyday life, although a further decrease in these sensory disturbances is to be expected in the next months in accordance with the literature.
There was no accumulation of further significant complications in any of the groups.
It can be stated with regard to surgical approach and the rehabilitation outcome that the implantation of a total hip endoprosthesis in both minimally invasive and conventional form is a very safe operation. 100 % of the patients examined would have this operation performed again in retrospect.
Since both the operation and the follow-up treatment are in a dynamic process, the data collected in this study should also be further evaluated and analyzed within the framework of more up-to-date, preferably multicenter studies in order to provide surgeons with even more precise information on the further development of the methods and the advantages and disadvantages of the surgical approaches.
Furthermore, it was examined whether the rehabilitation management by the rehabilitation insurance funds was decided in accordance with the patients' right to choose. This was the case with regard to the rehabilitative setting, but not in every case with regard to the chosen facilities. The patient's right to choose the rehabilitation facility should be respected, as this led to significantly higher patient satisfaction in this study than if the patient was assigned the rehabilitation facility.
In the context of an ICF-based evaluation, a disturbed sleep function was shown to be a burden for the patient, so that this should be given greater consideration in the development of new questionnaires, as the most current ones hardly reflect this.
Summary: This study has demonstrated the advantages of the minimally invasive anterior approach to the hip joint compared to the Bauer approach, particularly with regard to patient rehabilitation.
The significantly faster postoperative mobilization, the shorter hospital stay and the differences between the groups in terms of mobility and ADL activities after 6 months, which were also demonstrated here, speak in favor of performing a total hip arthroplasty via a minimally invasive anterior approach. On the other hand, there is the possibility of a persistent sensory disturbance in the area supplied by the lateral femoral cutaneous nerve after 6 months, which does not occur with the conventional surgical method.
The patient should be informed about these differences so that he or she can make a free decision regarding the surgical approach.
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This item has been published with the following license: In Copyright