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Reducing Complications with Two-Incision Minimally Invasive Hip Surgery
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Posted on: 09/28/2006
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In this report, surgeons from the University of Missouri School of Medicine present their surgical technique for a total hip replacement (THR). They used a two-incision method that is minimally invasive (MI).
All 89 patients received an uncemented THR. The surgeon used a special imaging called fluoroscopy to guide them. Fluoroscopy is very helpful in checking to make sure the position of the hip and implant is correct.
A step-by-step description of the operation is given with some tips on how to reduce complications. For example, the patient's hip is placed in a slightly flexed or bent position. This is designed to relieve tension on the nerve along the front of the thigh.
And fluoroscopy was used to find the exact spot for the incision. This step can also reduce the risk of nerve damage. At the end of the study, the authors suggested that fluoroscopy shouldn't be relied upon. The surgeon is better off using anatomic landmarks to get the best implant positioning. Other advice offered included placement of reamers, use of lighting, patient positioning, and specifics about cup alignment.
The results for these 89 patients are compared with the outcome of 96 THRs using a single mini-incision technique. All operations were done by the same surgeon. The two-incision MI method had a 10 per cent reoperation rate.
This was compared to a six per cent repeat surgery rate for the standard one-incision method. Likewise, there were many more other problems reported and linked with the two-incision MI compared with the one-incision procedure.
Overall results improved with practice and increased experience using the two-incision approach. The authors conclude that even with fluoroscopy to guide the operation, the complication rate is high with a two-incision MI. Patients must be chosen carefully for this procedure. The surgeon must have special training and practice on cadavers before doing this on live humans.
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References:
B. Sonny Bal, MD, MBA, et al. Early Complications of Primary Total Hip Replacement Performed with a Two-Incision Minimally Invasive Technique. In The Journal of Bone & Joint Surgery. September 2006. Vol. 88-A. Supplement 1, Part 2. Pp. 221-233.
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