Document Detail


Functional recovery, complications and CT positioning of total hip replacement performed through a Röttinger anterolateral mini-incision. Review of a continuous series of 103 cases.
MedLine Citation:
PMID:  22209043     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Minimally invasive approaches entail an increased risk of malpositioning and peri-operative complications. Most studies analyzed these data only on plain X-ray rather than computed tomodensitometry (CT) in assessing implant positioning.
HYPOTHESIS: A Röttinger minimally invasive anterolateral (MIS-AL) approach provides rapid complication-free functional recovery with reliable implant positioning on CT-scan.
PATIENTS AND METHOD: One hundred and three primary cemented total hip replacements (THR) performed by a single surgeon using a MIS-AL approach underwent clinical assessment at six weeks and three, six and 12 months on X-ray, including CT and postoperative myoglobinemia and creatine phosphokinase (CPK).
RESULTS: Pain, on a visual analog scale, was graded less than 1 at 36 hours; canes ceased to be used at a mean three weeks; and mean Postel-Merle-D'Aubigné score at six months was 17.36 (range, 13-18). There were ten approach-related complications (9.7%: one femoral perforation, two dislocations, two femoral neck fissures, two cases of meralgia paresthetica and three of tensor tendinitis). Mean CPK level was 390.9 ± 252μg/L (range, 88-1095μg/L) at 24 hr postoperatively and 319 ± 256μg/L (95-1028 μg/L) at 48 hr. Mean postoperative myoglobinemia was 299 ± 152.6μg/L (75-914μg/L). Mean acetabular inclination and anteversion on CT were respectively 44.7° ± 4.6° (34° - 56°) and 9.2°±9.2° (-17°-35°) and mean femoral anteversion 23.5° ± 9.4° (2°-53°).
DISCUSSION: Functional recovery was quick, but with an 8.7% complications rate (excluding four cases of spontaneously resolved tendon pain). CT showed reliable cup positioning, but a wide scatter in femoral anteversion. Elevated muscle enzyme levels possibly testified to approach-related tissue attrition. The MIS-AL approach involves a learning curve to avoid femoral perforation. It provided rapid functional recovery with reliable positioning, at least for the cup, and a low rate of associated complications.
LEVEL OF EVIDENCE: III, prospective continuous study.
Authors:
C Mandereau; V Brzakala; J Matsoukis
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2011-12-29
Journal Detail:
Title:  Orthopaedics & traumatology, surgery & research : OTSR     Volume:  98     ISSN:  1877-0568     ISO Abbreviation:  Orthop Traumatol Surg Res     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-02-10     Completed Date:  2012-07-12     Revised Date:  2013-10-31    
Medline Journal Info:
Nlm Unique ID:  101494830     Medline TA:  Orthop Traumatol Surg Res     Country:  France    
Other Details:
Languages:  eng     Pagination:  8-16     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Masson SAS. All rights reserved.
Affiliation:
Charles-Nicolle University Hospital Center, Rouen, France. gabacho@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip / methods*
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Osteoarthritis, Hip / physiopathology*,  radiography,  surgery
Patient Positioning
Postoperative Complications / epidemiology*,  physiopathology
Prospective Studies
Range of Motion, Articular / physiology*
Recovery of Function*
Surgical Procedures, Minimally Invasive / methods*
Time Factors
Tomography, X-Ray Computed
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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