Standard Operating Procedures
Dotaz
Zobrazit nápovědu
V práci jsou uvedeny krátkodobé zkušenosti s rekonstrukčními operacemi u ruptur rotátorové manžety, které byly provedeny podle v současnosti uznávaných zásad u dvaceti pěti pacientů (26 ramen) v období 1993-1996. V souboru převažovali muži (16 mužů) a většina pacientů byla ve věkovém rozmezí 50-70 let. Doba sledování byla 6-36 měsíců. Převažovaly masivní ruptury s defektem manžety větším než 5 cm (10krát) a dále ruptury s defektem do 2 cm (9krát). U většiny operovaných byla operace provedena z Kesselova-Gschwendova přístupu. Po přední akromionplastice byly šlachy manžety uvolněny a fixovány do záseku mezi kloubní plochou hlavice a velkým hrbolem. Operovaná končetina byla upevněna na abdukční dlaze na dobu 4-6 týdnů a potom následovala řízená rehabilitace na 1-2 měsíce. Podle Constantova funkčního skóre byl výborný výsledek dosažen u 31 % operovaných, dobrý výsledek u 35 % operovaných, uspokojivý u 11 % a neuspokojivý u 23 % operovaných. Uvedené výsledky jsou ve shodě především se subjektivním hodnocením a hodnocením bolesti v důsledku subakromiální dekomprese. Funkční výsledek je v souladu především s dosaženým rozsahem hybnosti ramene, u většiny pacientů však přetrvává výrazné omezení síly v abdukci v důsledku svalové hypotrofie při převážném zastoupení zastaralých masivních ruptur. Neuspokojivé výsledky byly zaznamenány u šesti pacientů s následujícími příčinnými souvislostmi: reo perace v subakromiálním prostoru, mechanické selhání sutury, hluboký infekt při diabetes mellitus, operace V důsledku pracovního úrazu se snahou o odškodnění a úporný cerviko-brachiální syndrom, ovlivňující stav ramenniho kloubu. Z těchto prvních zkušeností vyplývá, Že rekonstrukce rotátorové manžety jsou velmi úspěšné při správné indikaci, důsledném technickém provedení a důsledné pooperační fixaci a rehabilitačním doléčení.
The author presents his short-term experience with reconstruction operations in ruptures of the rotator cuff which were performed according to principles accepted at present in twenty five patients (26shoulders) during 1993-1996. Men predominated in the group (16 men) and the majority of patients were in the age bracket from 50-70 years. The follow-up period was 6-36 months. Massive ruptures with a lesion of the cuff exceeding 5 cm (10 times) predominated, followed by ruptures with a lesion under 2 cm (9 times). In the majority of patients the operatoin was made using the Kessel-Gschwend approach. After anterior acromionplasty the tendons of the cuff were released and fixed into the ridge between the articular area of the head of he joint and the large tubercle. The operated extremity was fixed on an abduction splint for 4-6 weeks and this was followed by controlled rehabilitation for 1-2 months. According to Constant's functional score excellent results were achieved in 31 % of the operated patients, a satisfactory result in 11 % and an unsatisfactory resu t in 23 % of the operated patients. The presented results are consistent above all with the subjective evaluation and evaluation of pain resulting from subacromial decompression. The functional result is consiostent with the achieved extent of mobility of t shoulder. In the majority of patients however marked restriction of strength in abduction persists due to muscular hypotrophy asa result of predominating inveterate massive ruptures. Unsatisfactory results were recorded in six patients reoperation in the subacromial space, mechanical failure Of the suture, deep infection in diabetes mellitus, operation of an occupational injury with attempted compensation and refractory cervicobrachial syndrome with an impact on the shoulder joint. From this initial experience ensues that reconstructions of the rotator cuff are successful provided the indication is correct, the operation is of a high technical standard, and consquential postoperative fixation and rehabilitation after treatment are provided.
- MeSH
- chirurgické operační výkony metody MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- poranění ramene MeSH
- poranění rotátorové manžety MeSH
- ramenní kloub chirurgie MeSH
- rameno chirurgie MeSH
- rehabilitace MeSH
- rotátorová manžeta chirurgie MeSH
- rozsah kloubních pohybů MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
PURPOSE OF THE STUDY The author presents the results of treatment with total hip arthroplasty (THA), in the Aldinger modification, in 91 patients receiving a total of 98 custom-made total hip implants in the period from 1993 to 2002. Eighty-eight patients (96.9 %) with 95 THAs were available for evaluation at the last follow-up. MATERIAL The group comprised 26 men (27 total hip implants), at an average age of 33.8 years (range, 25-57), and 65 women (71 implants) at an average age of 38.5 years (23-57) at the time of surgery. The right hip was operated on in 43 patients (18 men and 25 women) and the left one in 55 patients (9 men and 46 women). One man and six women underwent bilateral THA. The average time between the operation and the last follow-up was 8.6 years (range, 3 years and 11 months to 13 years and 3 months). METHODS The author describes the complete procedure from indications, planning and manufacture of an custom made implant to its implantation in combination with different types of acetabulum. The evaluation based on the Merle d'Aubigne score system, as modified by Griss, was carried out for an average follow-up of 8.6 years. RESULTS The outcomes were excellent, good and satisfactory in 69 (72.7 %), 16 (16.8 %) and 8 (8.4 %) patients, respectively. Two patients with septic complications (2.1 %) reported poor results. The overall complications involved aseptic loosening of the acetabulum in five, septic loosening of the acetabulum with severe lesions due to polyethylene wear in three, and infection in four patients. Eight cases were associated with periarticular ossifications and three patients developed deep venous thrombosis in the post-operative period. DISCUSSION The prerequisite for good outcomes in total hip arthroplasty using cementless implants is, in the author's opinion, the attainment of high primary stability. One of the options to achieve this is a thorough analysis of proximal femoral morphology on CT scans, which permits the construction of an custom made implant to each individual femur on the form-fit principle. Other advantages include a possibility to adjust the torsion angle of the femoral neck, to plan correction of limb length and to restore femoral offset, which provides conditions for optimal geometry of the hip joint. The excellent and good outcomes recorded in nearly 90 % of our patients at an average of 8.6 years of follow up are in agreement with the literature results. The fact that most of our complications were due to aseptic loosening of the acetabulum suggests that the use of a custom-made hip implant does not resolve the problems associated with acetabular dysplasia. A true loosening of the custom made stem occurred in only two cases with septic complications, in which any other type of stem would have behaved in a similar way. The same findings are also reported by other authors. CONCLUSIONS The results of this study show that the idea of exact adjusting of an implant to the bone (not vice versa) could meet the requirement for the implant's long life span and could allow for better physical therapy in the post-operative period, particularly in young patients with secondary post-traumatic or post-dislocation arthritis of the hip. Cemented hip implants, however, remain the gold standard for patients over 70 years. In younger patients it is necessary to put more emphasis on stable primary fixation, which can be achieved by 3D reconstruction of the joint to be replaced, by imaging methods and a subsequent computer processing of the procedures for designing, manufacturing and inserting the hip prosthesis.
- MeSH
- lidé MeSH
- muži MeSH
- náhrada kyčelního kloubu metody trendy MeSH
- ortopedické výkony metody využití MeSH
- pooperační komplikace klasifikace MeSH
- výsledek terapie MeSH
- ženy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- srovnávací studie MeSH
PURPOSE OF THE STUDY In this double-blind prospective study, pain after reconstruction of the anterior cruciate ligament (ACL) was evaluated using the visual analogue scale (VAS). Comparisons were made between patients administered an intra-articular analgesic mixture of adrenaline, morphine and bupivacaine (Marcaine) and those without it, between patients surgically treated by the BTB technique and those undergoing hamstring tendon ACL reconstruction, and between men and women undergoing the same procedure. MATERIAL Eighty-five randomly selected patients were allocated by five groups according to the surgery performed: 1. ACL reconstruction by the BTB technique, without administration of the analgesic mixture (20 patients); 2. hamstring tendon ACL reconstruction, without the analgesic mixture (20 patients); 3. ACL BTB technique with intra-operative, intra-articular analgesia (20 patients); 4. hamstring tendon ACL reconstruction, with intra-operative, intra-articular analgesia (20 patients), 5. ACL reconstruction using a cadaver graft, without intra-operative analgesia (5 patients). METHODS ACL reconstruction was carried out, in tourniquet-induced ischemia, by one of the standard techniques mentioned above. An analgesic mixture of adrenaline (1 ml/1 mg), morphine (1 ml/10 mg) and Marcaine (0.5 %/20 ml) was administered into the joint under arthroscopic control before the procedure was terminated. In all cases, the drain was released at 30 min. after the end of surgery. The limb was immobilized in a brace and the joint was cooled with ice. When requested, intramuscular analgesics (Dolmina and Dipidolor) were given. VAS pain scores were recorded at 30 min, 1, 2, 4, 8, 12 and 24 h after surgery. The range was from 0 (no pain) to 10 (maximum pain) scores. In addition, the amount of intramuscular analgesics and the time of their administration after surgery were noted. RESULTS VAS pain scores were lowest in the patients with ACL reconstruction by cadaver BTB grafting, the highest scores were reported by the patients with autologous BTB graft reconstruction. Women perceived the operation as more painful than men. When the intra-operative analgesic mixture was used, the amount of post-operative opiate analgesics was reduced by 29 % and 46 % in group 3 and group 4 patients, respectively, and in group 3 its administration was postponed (first administration after an interval 1.7-times longer than in group 4). The number of patients not requiring any opiate drugs increased markedly in both these groups. Intra-operative analgesia resulted in only a slight decrease in VAS pain scores, more in group 3 than group 4. DISCUSSION Several analgesics are used for intra-articular administration in order to alleviate post-operative pain. The most frequently used drugs include bupivacaine, morphine or epinephrine, but their mixtures are more effective than any of the drug administered alone. The most apparent evidence of the effect was the reduced amount of opiate drugs required after surgery, which was significant in all patients treated with intra-articular analgesia (groups 3 and 4) and particularly in men. However, VAS pain scores in the two groups decreased only slightly. Since maximum pain is experienced at the graft donor site, the effect of the evaluated mixture is regarded as complementary and multi-modal analgesic therapy is recommended. CONCLUSIONS The use of intra-articular analgesia has a significant effect on the reduction of opiate amounts administered to patients during the 24-hour post-operative period after ACL reconstruction, regardless of the surgical technique used. These patients also reported slightly lower perception of pain, as assessed by the VAS pain score. The effect was higher in men than in women.
- MeSH
- analgetika klasifikace terapeutické užití MeSH
- artroskopie metody trendy využití MeSH
- injekce intraartikulární trendy využití MeSH
- koleno chirurgie MeSH
- lidé MeSH
- ligamentum cruciatum anterius chirurgie MeSH
- muži MeSH
- pooperační bolest farmakoterapie terapie MeSH
- prospektivní studie MeSH
- ženy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- srovnávací studie MeSH
PURPOSE OF THE STUDY In this study the results of arthroscopic repair of massive rotator cuff tears are evaluated and compared with those of mini-open surgery published in Part 1. MATERIAL By the year 2006, of 176 patients undergoing the reconstruction of massive rotator cuff tears in our department, 77 were treated by arthroscopy. In this group there were 50 men; the dominant arm was operated on more frequently (60x). The average age of the patients was 55 years (range, 37-74). METHODS Surgery is carried out under combination of general anesthesia and an interscalene brachial plexus block, in a lateral recumbent position, with traction applied to the axis of the limb abducted at 40 degrees. Standard arthroscopic portals are used. After exploration of the glenohumeral Joint and thorough bursectomy, the torn rotator cuff tendons are mobilized and an insertion site is prepared. Using Spiralok (Mitek) anchors loaded with two Strands of Orthocord suture, the tendons are re-attached with mattress stitches by means of an arthroscopic grasper (Mitek). We use the Standard single-row technique with re-insertion at the original site. in indicated cases we carry out tenotomy or tenodesis of the long head biceps tendon. Acromionplasty follows only in type III acromion cases. After surgery the limb is immobilized in a Gilchrist bandage for 5 weeks during which, in accordance with the strength of re-attachment, passive exercise is carried out. Rehabilitation therapy should continue for 6 months at least. The results were evaluated on the basis of the UCLA (University of California at Los Angeles) shoulder rating System and the Constant scoring System. Using the school marking System (1, best; 5, worst) we asked about patients' satisfaction with surgery and their willingness to undergo the same Operation again. RESULTS Of the 77 patients treated for massive rotator cuff tears by arthroscopic repair up to 2006, 40 were fully evaluated.The average pre-operative Constant score was 48.4 (26-83) points and the UCLA score was 13.8 (6-25) points; post-operatively, these values increased up to 85.45 and 30.35 points, respectively. In addition to rotator cuff repair, we performed tenotomy or tenodesis of the long head biceps tendon (31x; in seven cases a tendon rupture was present), acromioplasty (17x), acromioclavicular Joint resection (3x), subscapular muscle reconstruction (5x) and treatment for shoulder instability (3x). In four patients we recorded the following complications: transient paresis of the upper extremity one, infection in one, and long-term secretion from the ventral portal in two patients. They were completely treated. All patients were satisfied with the treatment outcome and expressed willingness to undergo the surgery again, if needed. DISCUSION Although the arthroscopic repair of a massive rotator cuff tear is a technically demanding procedure with a long learning curve, since 2005 all rotator cuff repairs at our department have been carried out arthroscopically The results achie-ved are comparable with those of the mini-open surgery and, in addition, this method allows us to treat all co-existent pathologies at one stage. The Spiralock anchor (Mitek) proved to be an optimal implant for re-attachment of the rotator cuff tendons. No evaluation of a similar patient group is available in the relevant Czech literature, but the results are in agreement with those of published international studies. CONCLUSION Arthroscopic rotator cuff repair can be recommended as the procedure fully comparable with the open technique. Becau-se of the possibility to diagnose and treat all shoulder pathologies at one stage, all rotator cuff repairs at present carried out at our department are arthroscopic procedures.
- MeSH
- artroskopie klasifikace metody využití MeSH
- interpretace statistických dat MeSH
- magnetická rezonanční tomografie metody využití MeSH
- miniinvazivní chirurgické výkony ekonomika metody statistika a číselné údaje MeSH
- poranění rotátorové manžety MeSH
- poranění šlachy chirurgie komplikace patologie MeSH
- radiografie metody využití MeSH
- rotátorová manžeta chirurgie MeSH
- ruptura chirurgie MeSH
PURPOSE OF THE STUDY The aim of this prospective randomized study was to compare, by means of biochemical markers, the operative invasiveness of the standard total hip replacement with that of the minimally invasive anterolateral (MIS-AL) approach. MATERIAL Twenty-six randomly assigned patients with standard and 22 patients with MIS-AL total hip replacement were included in the study. Patients with elevated pre-operative levels of the markers evaluated or patients taking medication that might affect marker levels were not included. METHODS Creatine phosphokinase (CPK) and C-reactive protein (CRP) were chosen as markers of muscle damage and post-operative inflammatory changes, respectively. Blood samples were drawn before surgery (less than 24 hours) and after surgery at 24, 48 and 96 hours, which respected biological half-lives of the markers and permitted us to study their dynamics. The results were evaluated and statistically analyzed at the department of biochemistry, using the two sample f-test. RESULTS Statistically significant differences between the two groups of patients were found for both markers. The average CRP values differed significantly (p <0.05) at 48 and 96 hours post-operatively, being higher for the standard than MIS-AL total hip replacement by 28 % and 44 %, respectively. The average CPK values showed the most marked difference at 48 hours after surgery, when the level was higher by 62.5 % in the standard than MIS-AL total hip replacement (p < 0.05). DISCUSION Our objective evaluation of the invasiveness of surgery in total hip replacement was based on the most frequently recommended markers for assessment of muscle tissue damage and post-operative inflammatory changes. The study was focused on the invasiveness of surgery only and neither subjective nor objective outcomes of implantation were evaluated. The use of the muscle sparing approach MIS-AL results in minimal damage to muscle tissue and, consequently, a lower degree of post-operative inflammation than is recorded in traditional hip replacement surgery. CONCLUSIONS In the patients undergoing MIS-AL total hip replacement, post-operative levels of CPK and CRP were significantly lower than in the patients with standard total hip replacement. The MIS-AL technique evidently provides a more sparing approach to soft tissues.
To evaluate our experience with the use of a retrograde nail locked in the sagittal plane for tibiotalocalcaneal arthrodesis indicated in severe post-traumatic arthritis of the ankle. MATERIAL: Twenty patients, 16 men and four women at an average age of 58.7 years (range, 23 to 72) were evaluated. All patients had severe post-traumatic changes in the talocrural and talocalcaneal joints. Five patients also had an equinus deformity. In two patients arthrodesis followed the treatment of purulent arthritis of the talocrural joint. A local fasciocutaneous flap was used for soft tissue reconstruction in three patients. All patients were operated on using the standard surgical technique. METHODS With the patient in a supine position, reamed by hand with the use of a driving rod, a straight retrograde AAN Orthofix nail was inserted through the heel bone and talus into the distal tibia and locked in these bones in the sagittal plane. RESULTS: No complications such as injury to the neurovascular plexus or pseudoarthrosis were recorded. Four patients showed a reaction to the proximal locking screw on the proximal tibial surface, which was treated by earlier screw removal under topical anaesthesia. Due to infectious complications, the nail had to be removed prematurely in one patient. The average Foot Function Index was 12 points (range, 10 to 15) and the average ankle-hindfoot score was 67.6 points (range, 59 to 84). Thirteen patients (65 %) were not limited in their daily activities or recreational sports, six (30 %) experienced pain in sports but not daily activities and one patient (5 %) reported pain even when walking. All fusions healed in the correct position within 18 weeks. DISCUSSION: Tibiotalocalcaneal arthrodesis is not a frequent surgical procedure in either trauma surgery or orthopaedics. For this complicated procedure, rather than intramedullary nails, internal fixation with screws or plates or external fixation are preferred. The high rate of bony healing can be explained by maintenance of exact nail locking in the sagittal plane. The antero- posterior approach provides a more secure locking in the bone and assists in neutralizing sagittal forces at the site of arthrodesis. The use of reamed interlocking nails can therefore be accepted not only for treatment of long-bone fractures, but also for treating pseudoarthrosis and in complicated or failed arthrodesis. CONCLUSIONS: Patients' satisfaction is the primary goal we strive to achieve in severe post-traumatic conditions of the talus and foot. Repeat surgery, spongioplasty, external fixation revision for pin-tract infection, persistent pain, activity restriction and poor clinical results reduce patients' satisfaction. In our group, the rate of healed arthrodesis was high and the number of complications was low, therefore our patients' satisfaction was high.
- MeSH
- artritida etiologie chirurgie MeSH
- artrodéza metody MeSH
- dospělí MeSH
- kostní hřeby MeSH
- lidé středního věku MeSH
- lidé MeSH
- patní kost chirurgie MeSH
- poranění kotníku komplikace MeSH
- senioři MeSH
- talus chirurgie MeSH
- tibie chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
To evaluate the efficacy of magnetic resonance (MR) examination in intra- and extra- articular shoulder disorders, in comparison with arthroscopic findings, in patients with both acute injuries and chronic problems of the shoulder. MATERIAL AND METHODS: Conventional MR images and MR arthrograms of the shoulder were obtained in 35 patients treated between January 2004 and January 2006. Each MR image was evaluated by five radiologists experienced in assessing findings on the musculoskeletal system. Subsequently, the patients underwent shoulder arthroscopy performed by shoulder arthroscopy surgeons. Each detailed arthroscopic report was compared with the pre-operative MR findings, and the sensitivity and specificity of MR examination were calculated. The arthroscopic findings served as standards of reference for comparison. RESULTS: SLAP lesions were found intra-operatively in seven out of the 35 patients (20 %). MR sensitivity was 43 % (3 to 7 patients) and specificity was 96 % (27 to 28). The accuracy of MR for SLAP lesion diagnosis was 86 % (30 of 35 patients). Tears in the anterior labrum were diagnosed by arthroscopy in 16 of 35 patients (46 %); MR sensitivity was 44 % (7 of 16 patients) and specificity was 89 % (17 of 19). The accuracy of MR for diagnosing labral tears was 68 % (24 of 35 patients). DISCUSSION: When designing our study, we tried to avoid limitations of similar investigations.We employed a nuclear magnetic resonance system with high resolution and standardized both the arthroscopic technique and the evaluation of MR images. Our results of diagnosing rotator cuff disorders and SLAP lesions are in agreement with those of other relevant studies. The limitation of our study was a small size of the group. CONCLUSIONS: Although MR imaging is a sensitive method suitable for diagnosing some shoulder disorders, the MR imaging of SLAP lesions and labral tears does not give results accurate enough to be used for pre-operative planning.
To evaluate and compare proximal humeral fractures treated either by plate osteosynthesis with angular-stable screws or by intramedullary nailing, and to define the indications optimal for use of either technique. MATERIAL: The study comprised 97 patients. The proximal humeral internal locking system (PHILOS) plate was used in 49 patients (31 women and 18 men); with age average 57.4 years (women, 64.5 and men, 45.3 years). By the AO classification, 12 patients with type A, 15 with type B, and 22 with type C fractures. The Targon PH nail was used in 48 patients (32 women and 16 men) at an average age of 65.3 years (women, 72.2 and men, 51.4 years). Type A fractures were in 18, type B in 18 and type C in 12 patients. METHODS: The patients were prospectively evaluated and placed into the two groups.The post-operative range of motion was assessed by the Constant-Murley (CM) score at 6 weeks, and at 3, 6 and 12 months. The CM value was related to the healthy collateral limb and recorded as a relative CM score. RESULTS In the PHILOS group, the average values were: operative time, 76.2 min; X-ray exposure, 4.2 min; and relative CM score, 74.5 points. The Targon PH group showed the average operative time of 50.2 min., X-ray exposure for 4 min. and the relative CM score 78.3 points. There were no significant differences between the groups, with the exception of shorter operative time in intramedullary nailing. DISCUSSION: Nailing is the method of choice for two-fragment fractures. In comminutive metaphyseal fractures particularly, the use of nailing is more effective than plate osteosynthesis that carries the risk of plate detachment from the diaphysis. In fractures with a long fracture line extending into the metaphysis, plate osteosynthesis with open reduction is a better option. The results in three-fragment fractures are comparable and the choice of an implant is the matter of surgeon's preference. The standard technique for four-fragment fractures involves the use of angular-stable plate fixation through the deltoid- pectoral approach. Intramedullary nailing is a borderline indication requiring a modified surgical procedure, with tubercles being fixed with osteosuture. CONCLUSIONS: No statistically significant differences in functional results occurred between the observed groups at one year of followup. In four-fragment proximal humerus fractures, the patients treated with Targon PH nails had more complications and worse relative CM scores than those treated with PHILOS plates; however, this was not statistically significant and the number of complications decreased after the technique of tubercle osteosuture had been introduced. Finally, the only significant difference between the groups was a shorter operative time with the use of intramedullary nailing.
To present a prospective evaluation of one-year results in 162 patients undergoing total hip arthroplasty from a minimally invasive antero-lateral approach (THA MIS-AL). MATERIAL: A total of 249 THA MIS-AL procedures were performed between January 2005 and October 2007. At one year after surgery 162 patients were examined and their conditions evaluated by the Harris score, percent satisfaction assessment, 1-to-5 scale school marking, findings on lateral X-ray images and occurrence of post-operative complications. METHODS: With the patient lying in a lateral recumbent position, access is gained through a short incision (5 to 8 cm) along a line connecting the greater trochanter and the anterior superior iliac spine, between the gluteus medius and tensor fasciae latae muscles. After the articular capsule is removed and neck osteotomy done by a two-step procedures, the head is extracted. Both the acetabulum and the femur are processed with special instruments and a cemented or a cementless implant is inserted. Standard prophylaxis with antibiotics and anticoagulants is administered. The patient is mobilized from the second post-operative day, with individually allowed, partial weight-bearing of the operated extremity. RESULTS: In the 162 evaluated patients, the average Harris score increased from pre-operative 46.8 to post-operative 90.4 points. Excellent and good outcomes were found in 84% of the patients. The average school marking was 1.12 and patient satisfaction expressed in percent was 97%. Of 32 patients who had undergone both standard and minimally invasive hip replacement surgery, 25 considered the MIS AL technique to be better, five found no difference and two regarded is as worse. In two patients (0.8%), exposure had to be extended by the standard antero-lateral approach because of femur damage without displacement.Two patients (0.8%) suffered temporary post-operative peroneal nerve paresis. One patient (0.4%) had functional complications and five (2%) had to undergo surgery for haematoma. Sockets in a position other than the optimal 35 degrees to 55 degrees were recorded in two patients. The stem showed a 5 degrees varus deviation in one patient and that of 4 degrees in eight patients; a 4 degrees valgus deformity was found in three patients. Para-articular ossifications (stage 1 or 2) not affecting joint function were recorded in 20 patients (12%). DISCUSSION: Our results show good subjective evaluation of this technique. Its advantages include less pain and earlier patient mobilization. In our first patients a higher number of slight stem malposition (up to 3 degrees) was recorded. Early complications were rare. The occurrence of paraarticular ossifications was an unexpected finding; these, however, did not influence either joint function or subjective evaluation of the outcome. CONCLUSION: If all indication criteria are met and the operative technique is well mastered, the MIS-AL procedure helps provide successful outcomes with less muscle damage and more rapid rehabilitation for people receiving hip replacement; it has few complications and, in indicated cases, it appears to be an approach preferable to the standard THA technique.
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony MeSH
- náhrada kyčelního kloubu metody škodlivé účinky MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
