Modified two-incision minimally invasive total hip replacement for ankylosed hips
- PDF / 305,592 Bytes
- 7 Pages / 595.276 x 785.197 pts Page_size
- 23 Downloads / 188 Views
Case report Modified two-incision minimally invasive total hip replacement for ankylosed hips TAEK-RIM YOON, AZLINA AMIR ABBAS, KEUN BAE LEE, and KI-HYEOUNG KIM Department of Orthopaedics, Chonnam National University Hwasun Hospital, 160 Ilsimri, Hwasuneup, Hwasungun, Jeonnam 519-809, Korea
Introduction Ankylosis of the hip is defined as total loss of hip motion. Whether spontaneous or achieved surgically, ankylosis provides a durable, painless, and stable hip.1,2 However, in the long term, a fused hip may be associated with functional disability, such as pain in the lower back, contralateral hip, and/or either knee.1,2 Although the procedure is technically difficult because of the initial disease, previous surgery on bone and soft tissues, altered anatomy, and atrophy of abductor musculature,3,4 the benefits of converting an ankylosed hip to a total hip arthroplasty have been well documented.3,5–9 Relief of pain in the neighboring joints, improved mobility of the hip, and correction of limb-length discrepancy are the reasons most patients are satisfied with the results of this procedure.3,8 The method of fusion takedown in most of the literature includes a greater trochanteric osteotomy to maximize exposure.3,4,7,9–12 Subcutaneous adductor tenotomies were also frequently employed to improve the range of abduction of the hip.4,9,12 The level of the true acetabulum was determined after identification of the inferior margin of the acetabulum3 or by palpation of bony landmarks.8 The concept of minimally invasive surgery (MIS) for total hip replacement (THR) has received enormous attention. MIS offers the theoretical advantages of a better cosmetic result and less pain. In particular, the two-incision MIS technique constitutes a novel approach for hip replacement that employs intermuscular and internervous planes to gain access to the hip joint while minimizing the disruption of muscles and tendons.13,14 By decreasing the extent of tissue disruption, this technique may reduce intraoperative bleeding and postoperative pain and lead to a more rapid functional recovery Offprint requests to: T.-R. Yoon Received: April 17, 2008 / Accepted: August 5, 2008
during the follow-up period.15 However, there have been reports of a higher complication rate related to this approach,16 such as proximal femoral fractures17 and injury to the femoral and lateral femoral cutaneous nerves.16,18 In terms of function, other studies have noted no significant advantage between MIS and conventional primary THA.19,20 With our modification of this technique, we have had good results and a lower complication rate.14 There have been no reports on the conversion of a fused hip to a mobile joint with an MIS. The aim of this article was to report on our experience in converting fused hips to cementless THRs utilizing a modified twoincision MIS approach.
Materials and methods Four patients (five hips) with an average age of 37.5 years (range 30–49 years) and ankylosed hips underwent a modified two-incision MIS cementless THA in our center (Table 1). Th
Data Loading...
