Choice of Surgical Approach with Aloplastic Hip Surgery
Mithat Asotic, Farid Ljuca, Predrag Grubor, Mirza Biscevic, Milan Grubor
Med Arh. 2012; 66(4): 249-254
Introduction: From all deceases and injuries of femur, most surgical, medical, so-cial and economical difficulties and problems are created by deceases and fractures of femur neck. Aim of the paper: Aims of this research lie in the value of surgical approach (Hueter, Mooro and Gibson’s) when anchoring hip endoprosthesis. The following parameters were analyzed: Harris Hip Score before and after the surgery, the length of the surgical incision, duration of the surgery, the amount of transfu-sion used, post-surgery time of the first movement to the upright position and full weight bearing. Materials and methods: At the Orthopedic clinic in Travnik in the period from January 1st 2005 to December 31st 2009, 136 hip prosthesis were implanted. Out of that number, 56 hip prosthesis were implanted using Moor ap-proach, 34 using Hueter approach and 46 patients were exposed to postero lateral (Gibson’s) approach. All patients were treated in the same manner, operated by the same surgery team. Results: Hueter approach has the highest quality of surgical treatment as none of the patients had the value of the score of surgical treatment below 8. Using Hueter’s approach 16 patients had the value of the score of quality of the surgical treatment between 8 and 10, whereas 18 patients had the score of quality of surgical treatment above 10. The second quality surgical treatment is Gibson’s posteolateral approach at which 29 patients had the score of quality surgical treat-ment below 8, and 17 patients had the quality surgical treatment between 8 and 10. The worst quality of surgical treatment is Moor’s approach because all 56 patients had the quality surgical treatment below 8. Discussion: Implantation of total en-doprosthesis of dysplastic hip with adults is a demanding orthopedic surgery. The surgery of implanted hip as well as endoprosthetic materials have both improved at the satisfaction of both the patients and the surgeons. Excellent and extraordinary results were achieved over the time have become a standard. In spite of that huge surgery wound and long recovery have motivated surgeons to improve the surgery techniques. Conclusion: With proper instruments and endoprosthesis, Hueter ap-proach has advantages compared to Gibson and Moor’s approach of implantation of endoprosthesis of aligned hip.
1. Berger RA. The technique and early results of the two incision minimaly invasive total hip arthroplasty. Read at the the Thirty-first Open Scientific Meeting of the Hip Society and the Ninth Combined Open Meeting of the Hip Society and AAHKS. 2003 Feb. 8: New Orleans,LA.
2. Chimento GF, Pavone V, Sharrrock NE, Kahn BA, Cahill J, Scuico TP. Minimaly invasive total hiparthroplasty: a prospective randomised study. Read at the Annual Meet- ing of the American Academy of the Orthopaedic Sur- geons. 2003 Feb. 5-8: New Orleans, LA.
3. Kennon R, Keggi JM, Wetmore RS, Zatorski L, Keggi KJ.Anterior approach total hip arthroplasty via mini-inci- sion technique:expiriance with more than 6000 cases. Presented as a Scinetific Exibit at the Annual Meeting of the American Academy of the Orthopaedic Surgeons.2003 Feb. 5-8: New Orleans, LA.
4. Goldstein WM, Branson JJ, Berland KA, Gordon AC.Minimal-Incision Total Hip Arthroplasty. J Bone Joint Surg. 2003 85A, Suppl. 4: 33-38.
5. Fehring TK, Mason JB. Catastrophic Complications of Minimaly Invasive Hip Surgery. J Bone Join Surg. 2005; 87A: 711-714.
6. Berry DJ. Minimaly Invasive Total Hip Arthroplasty. Edi- torial. J Bone Joint Surg. 2005; 87A: 699-700.
7. Baščarević ZLj, Radojević BB, TimotijevićSS, Baščarević VD, Trajković GŽ, Blagojević Z. Minimalno inciziona to- talna artroplastika kuka, Acta clinica. 2008; LIII: 53-56.
8. Kyle FR. Fractures of the proximal part of th femur, JBJS AM. 1994; 76: 924-950.
9. Schatzker J, Tyle M. The rationa le of operative frac- ture care, 3th edition, Springer-Verlag Berlin Heidel- berg, 2005.
10. Schmidt AH, Jahangir AA. What’s New in Orthopae- dic Trauma. J Bone Joint Surg Am. 2009; 91: 2055-2066.
11. Dulić VB, Vučetić V, Tulić DG, Kadija VM,Todorović JA.Prelom vrata butne kosti, Acta clinica, 2003, 3(3): 55-64.
12. Asnis ES, Wanek-Sgaglione L. Intracapsular fractures of the femoral neck. J Bone Joint Surg Am. 1994; 76:1793-1803.
13. Moran GCh, Wen TR, Sikand M, Taylor MA. Early mor- tality after hip fractures: is delay before surgery impor- tant? J Bone Joint Surg Am. 2005; 87: 483-489.
14. Lu-Yao GL, Littenberg B, Wennberg J E. Outcomes after displased fractures of the femoral neck. A meta-analysis of one hundred and six published reports, J Bone Joint Surg Am. 1994; 76:15-25.
15. Lee PHB, Berry D, Harmsen WS, Sim HF. Total Hip Ar- throplasty for the Treatment of an Acute Fracture of the Femoral Neck. Long-term Results, The Journal of Bone and Joint Surgery., 1998; 80: 70-75.
16. Bhandari M, Devereaux PJ, Swiontkowski FM,Tornetta P, Obremskey W, Koval JK, Nork S, Sprague Sh, Schemitsch HE, Guyatt HG. Internal fixation compared with arthro- plast y for displaced fractures of the femoral neck: A Meta-analysis. J Bone Joint Surg Am. 2003; 85: 1673-1681.
17. Marković S, Jović P. Ušteda k r vi kod minima lno in- vazivnih pristupa u hirurškom zbrinjavanju preloma kuka. Zbornik sažetaka sastanka “A loplastika kuka”, Kraljevo, 2009: 34