[Complications on minimal access surgery for total hip arthroplasty]. / Complicaciones en cirugía de mínima invasión en el reemplazo total de cadera.

INTRODUCTION: Recently, the surgical approach for total hip replacement has been refined and has been reduced in size. Controversies exist between advantages and complications it can present. OBJECTIVE: To show the complications of total hip arthroplasty by means of minimal access approach. METHODS: Thirty six patients, 24 women and 12 men (mean age 48 years), grade IV hip arthrosis. Twenty four patients underwent cementless hip arthroplasty and 12 patients hybrid arthroplasty. The preoperative evaluation was done with Harris score. An initial lateral approach of 6 cm (100%) was performed. Complications were grouped on acetabular, femoral and soft tissue complications. RESULTS: Necrosis at the comissure of the wound was seen in 12 patients (33.33%), necrosis at the surface border of the wound in 10 patients (27.77%), mal positioning of the acetabular cup in 3 patients (8.33%), mal positioning of acetabular cup screws in 2 patients (5.55%), eccentric reaming of the acetabulum in one patient (2.77%), and femoral stem malalignment in one patients (2.77%). DISCUSSION: There are many reports on the advantages of minimal invasion total hip replacement but few on complications which include mal positioning of the acetabular cup, eccentric reaming of the acetabulum and femoral stem malalignment. Nevertheless, advantages include a decreased healing time and postoperative recovery with less pain and reduced blood loss. We recommend that this technique should remain in the hands of experienced orthopaedic surgeons.

[Acetabular reconstuction for loosening in uncemented hip revision surgery. A series of 18 cases]. / Reconstrucción acetabular por aflojamiento en cirugía de revisión de cadera no cementada. Una serie de 18 casos.

OBJECTIVE: To describe the clinical and X-ray outcomes of the use of structured bone autograft and uncemented extended-configuration acetabular cup in hip revision surgery. MATERIAL AND METHODS: Eighteen patients, 12 females (66.66%) and 6 males (33.33%), with a diagnosis of uncemented, aseptic acetabular loosening were assessed during the preoperative period, radiologically with the Paprowsky classification and clini cally with the Harris scale. They were considered for revision surgery and exchange of the acetabular component with a structured autograft and an extended-configuration, uncemented acetabular cup. They were reviewed during the period from January 2000 to June 2005. RESULTS: Mean followup was 48 months; according to the Paprowsky scale the acetabular deficiency was: grade I in 11 patients (61.11%), grade II in 5 patients (27.77%), and grade III in 2 patients (11.11%). The following uncemented cups were used: the Healy Flanged in 4 patients (22.22%), and the extended diameter cup in 14 patients (77.77%). The mean time to the assessment of radiological grafting was 14 weeks; the time to assisted weight bearing with a walker was 8 weeks, the time to full weight bearing with a walker was 10 weeks. CONCLUSION: The use of a structured autograft assures the integration and reinforcement of the acetabular bottom with a considerable length of time to healing of 8 to 12 weeks. The use of revision extended-configuration implants and their three-point fixation assures primary and secondary stability and helps the patient resume his activities.

[Minimally invasive surgery for total hip arthroplasty. A review of 36 cases]. / Cirugía de mínima invasión en artroplastía total de cadera. Revisi6ón de 36 casos.

INTRODUCTION: A new approach has been developed recently that considerable decreases the size of the skin incision and that has led to controversy around the advantages it offers. OBJECTIVE: To analyze the immediate postoperative course of patients considering the following parameters: operative time, blood loss, postoperative pain. To report the complications that occurred. MATERIAL AND METHODS: Thirty six patients, with a mean age of 48 years, with a diagnosis of grade IV coxarthrosis. Twenty-four patients underwent uncemented total hip arthroplasty, and 12 total hybrid hip arthroplasty. The preoperative Harris clinical assessment was applied and a lateral approach was used in all cases. The initial incision was 6 cm long (100%). RESULTS: The final incision was 6.5 cm in 26 patients (72.22%), 7 cm in 10 patients. Necrosis of wound commissures occurred in 12 patients, superficial necrosis of wound margins in 10 patients; no wound infections were reported. The mean operative time was 65 minutes for uncemented hips and 80 minutes for hybrid hips. Mean intraoperative bleeding was 150 ml. Mean postoperative pain was 3 in the VAS. Complications included performing a neo-acetabulum in one case, and a false passage of the femur component in one case. CONCLUSION: The minimally invasive approach for total hip replacement is indicated for patients with special characteristics. It is less invasive, safe, involves minimal bleeding, shorter operative time, and is reproducible. Moreover, it offers significant benefits during the immediate postoperative period when compared with the standard incision, since it involves ess pain and mobility is resumed sooner.