Total hip arthroplasty using the minimally invasive two-incision approach / 中华骨科杂志

ABSTRACT

Objective To investigate and discuss the feasibility and clinical outcome of the minimally invasive two-incision total hip arthroplasty. Methods From February to June 2004, 17 cases of the minimally invasive two-incision total hip arthroplasty were performed. There were 7 males and 10 females with an average age of 69 years from 58 to 75 years. Preoperative diagnosis of the patients included 5 of osteoarthritis, 4 of osteonecrosis and 8 of femoral neck fracture. The operations were performed with Versys cementless prosthesis and minimally invasive instruments provided by Zimmer Company. Operation time, blood loss, length of incisions, average postoperative hospitalization, and operation related complications were analyzed. Blood transfusion was performed while hemoglobin of the patients was less than 8 g. Results The patients were followed up from 6 to 12 months with an average of 8 months. The average operation time was 95 mins (85 to 170 mins). The average blood loss was 280 ml (190 to 450 ml) and blood transfusion was carried out in 4 cases of femoral neck fracture (average, 400 ml). The average length of anterior incision was 5.0 cm (4.6 to 6.5 cm) and that of posterior incision was 3.7 cm (3.0 to 4.2 cm). All the patients were ambulatory the day after surgery. 11 cases were discharged 5 days and 6 cases discharged 7 days after operation. Postoperative measurement on X-ray film showed that the average angles of abduction and anteversion of acetabular cup were 46?(43? to 55?) and 21?(17? to 23?) respectively. Proximal femoral split fracture occurred in one case, in which the fluoroscopy demonstrated the femoral component was stable and well positioned, and the patient walked without weight-wear for 2 months and was found with stable prosthesis evaluated at 3 and 6 months postoperatively. None of infection, dislocation or injury of vessel and nerve happened. Conclusion Anterior and posterior two-incision total hip arthroplasty has the advantages of muscle sparing, minimally invasive, less blood loss, rapid recovery; however, this technique is time consuming, special instruments and fluoroscopy are needed.