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Query: UNIPROT:P50502 (Hip)
 7,003 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Recently there has been increased interest in doing total hip replacement through small incisions. One such technique is the two-incision approach. After initial investigations into its feasibility, Zimmer developed a training program for surgeons interested in doing the so called MIS 2-Incision Hip Procedure. An "index case" study was initiated to track the early experiences of trained surgeons, which includes 159 surgeons who have completed such training and recorded data on their initial cases. The purpose of this report is to present the data available from this index case study regarding the process of developing proficiency with the two-incision total hip replacement. We found a significant decrease in the mean operative time and fluoroscopy time from the first to tenth case. Key complications did not show a systematic decrease as a function of case number for the first ten cases. Clarification of the entire learning curve for this technique requires further investigation but may last beyond case ten for many surgeons. In addition, data from this study suggests that patient characteristics and surgeon experience have a significant effect on the prevalence of complications with the two-incision technique. The evolution of minimally invasive joint replacement is clearly in its infancy. Complication rates and the demonstrated learning curve may be altered by changes in training and surgical techniques.
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PMID:Learning curve for the two-incision total hip replacement. 1557 93

The MIS anterolateral approach for hip replacement surgery uses the intermuscular plane between gluteus medius and tensor fascia latae. The patient is placed in the lateral position. Retractors with soft tissue friendly profile and an operating table with modified leg support are recommended. The technique provides very good exposure of the acetabulum and femur and preserves muscle integrity so that rehabilitation can be rapid. Currently the experience comprises over 1000 primary cases performed using the MIS anterolateral approach since March 2003. The clinical results including pain, blood loss, range of motion, functional score, Harris Hip Score, and radiographic studies are based on the complete examinations of 48 consecutive patients. There are significant differences with improved clinical results compared with patients after standard approaches. After a fundamental learning curve there is no evidence of increased complications. The anterolateral approach is a standard approach suitable for wide application. The experience includes difficult primary cases like dysplasia, rheumatic disease, and ankylosis and even for revision surgery the technique can be routinely used. Restrictions are not known either in patients' characteristics or in indications.
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PMID:[The MIS anterolateral approach for THA]. 1671 90

We evaluated early clinical results and radiographic findings of MIS THA using 2-incsion approach and mini-posterior approach. A consecutive series of 35 patients (40 hips) with 2-incision THA and a consecutive series of 35 patients (36 hips) with mini-posterior THA performed in the same period were evaluated. The patient groups were not randomised. At the mean follow-up of 20.2 months (range, 12-36 months), the 2-incision group had significantly earlier ambulation, driving ability and return to work. However, it had significantly more operative time, blood loss, blood transfusion and complications. Regarding radiographic findings of 2-incision group and mini-posterior group, the mean radiographic acetabular abduction of was 46.7 degrees (89% was within 35- 55) and 44.8 degrees (84% was within 35-55), respectively. The femoral stem was in neutral position in 80% and 83%, respectively. There was no statistical difference of the implant position between groups. Although MIS 2-incison THA provided faster, early ambulation than the mini-posterior THA, surgeons have to weigh the advantages and disadvantages of this technique including, increased operative time, blood loss and their familiarity with similar standard incisions and landmarks.
Hip Int 2006
PMID:Early outcomes following minimally invasive total hip arthroplasty using a two-incision approach versus a mini-posterior approach. 1921 24

We sought to determine whether a non-originating surgeon early in his experience with the MIS two-incision technique for THA could place components with appropriate accuracy. Thirty five consecutive hip replacements performed between July of 2003 and March of 2004 using the two-incision technique were closely matched by height and weight with an equal number of control small incision arthroplasties. The two-incision surgeries were performed after the surgeons twentieth case and prior to the surgeons fifty sixth two-incision case. We assessed immediate postoperative films for leg length discrepancy and acetabular position, and compared the two groups by chi squared analysis. Both leg length accuracy and abduction angle were significantly superior with the two-incision technique. No arthroplasty performed with the two-incision technique had a leg length discrepancy of more than 10 mm, versus five in the control group (p<0.025). The abduction of one cup fell outside the 35-49 range in the two-incision group, while ten did so in the control group (p<0.01). With this study, we have shown that a non-originating surgeon early in his experience with the MIS two-incision technique can place acetabular components and equalise leg lengths with superior precision. We believe the fluoroscopic control and supine position greatly enhance the surgeons accuracy, and more than compensate for the potentially decreased direct vision with this technique.
Hip Int 2006
PMID:Improved accuracy of acetabular component position and leg lengths with the two-incision total hip replacement technique. 1921 25

Between 2003 and 2005, a total of 425 consecutive cases with a modified two-incision minimally invasive total hip arthroplasty (THA) were performed at our hospital. We analysed 225 cas-es with greater than 12 months follow-up clinically and radiographically. The mean operative time was 70 minutes. Patients could walk on crutches at 1.5 days and discontinued crutch use at an average of 3 weeks. Patients were able to walk upstairs without support at 4 weeks. Radiographic analysis showed the mean lateral opening angle and anteversion of the acetabular components were 43.0 and 17.3, and 97% of the femoral stems were in neutral alignment. There was no radiographic evidence of component migration or subsidence at the most recent follow-up. Therefore, from these early results, a modified two-incision THA was found to be an excellent surgical modality, which allows early rehabilitation and does not increase complications when compared to other MIS two-incision THA techniques.
Hip Int 2006
PMID:A modified two-incision minimally invasive total hip arthroplasty: technique and short-term results. 1921 26

The purpose of this study was to describe the surgical technique and to investigate results of a modified two-incision total hip replacement using either intraoperative fluoroscopy or imageless navigation. Twenty-nine patients (30 hips) with a minimum follow-up of one year were enrolled in this study. The patients were evaluated at 3, 6, 12 weeks, 6 months, and 1-year. The functional recovery as represented by the Harris hip score and WOMAC scale were better in the fluoroscopy group of patients at the early postoperative stage (3 wks). Thereafter, both groups showed rapid recovery with no difference in scores. Injury to the lateral femoral cutaneous nerve was the most commonly seen complication and it occurred in 6 hips (fluoroscopy 2; imageless 4). The symptoms were transient and resolved in 6 months in all 6 cases. This study demonstrated that the role of intraoperative fluoroscopy could safely be replaced by an imageless navigation system for the MIS-2 THA.
Hip Int 2006
PMID:Two-incision total hip replacement: Intra-operative fluoroscopy versus imageless navigation for cup placement. 1921 27

The purpose of this study is to describe our early experience in the development and use of a minimally invasive, anterolateral approach to the hip joint for total hip arthroplasty (THA). This approach uses a specific intraoperative protocol involving leg positioning to maximise exposure and hip joint visualisation. Between October, 2004 and December, 2004, we operated on 18 male and 29 female patients without selection and in consecutive order. The average patient age at surgery was 66 years (range 28 to 86 yrs) with an average body mass index (BMI) of 26 (range 18 36) and with a majority of patients presenting with osteoarthritis as the primary indication for surgery. The average length of the skin incision was 8 cm and the average incision-to-suture time was 45 minutes. The preoperative average Harris Hip Score was 38 and improved to 70 at 10 days postoperatively, and 92 at three and six months. Similarly, the HHS average pain component score increased from 12.6 preoperatively to 39 at 10 days postoperatively, and 40 at three and six months. An exact neutral implantation of the stem was found in 48% of the patients, between one to three degrees out of neutral in 40% and greater than four degrees of varus in 12%. The average inclination angle of the cup was measured at 44 degrees. No intraoperative or perioperative complications of any kind occurred in this series of 47 consecutive patients. From our experience, the MIS AL approach for THA with patients in the lateral position can be applied without restrictions for patient indication. Improved results can be observed when using the MIS AL approach, especially in the ear-ly postoperative phase. Since the abductors can be completely spared during the surgery, improved long-term results may be expected. Moreover and when necessary, an operative expansion is always possible without difficulties. Overall, the approach yields promising results.
Hip Int 2006
PMID:Minimally invasive anterolateral surgical approach for total hip arthroplasty: early clinical results. 1921 28

The purpose of the review is to report the modified Smith-Peterson technique for use with minimal invasive total hip arthroplasty (MIS THA) with supine patient positioning. The modified Smith-Peterson technique allows for direct visualisation of the acetabulum and is an internerval approach. The MIS anterior approach with supine patient positioning offers a complete intermuscular and internervous access to the hip joint. The use of this technique yields a reduction of muscular trauma, intraoperative bloodloss, and postoperative rehabilitation. The reduction of soft tissue trauma may lead to minimal postoperative pain. While cosmesis is never a reason for using MIS, it does yield great patient satisfaction. The MIS anterior approach with supine patient positioning is a safe and reproducible method, offering an alternative option in MIS THA.
Hip Int 2006
PMID:The minimal invasive surgery anterior approach with supine patient positioning: a step-wise introduction of technique. 1921 29

The objective of this study was to show model-based economic consequences of minimal invasive surgery total hip arthroplasty (MIS THA). The model is based on hospital and rehabilitation costs and lowering of loss of productivity. This study used conventional THA data from Switzerland and cost-effectiveness MIS THA analysis from the United States. According to our model, a total of 42.1 70.1 million can be saved annually in Switzerland when using MIS THA instead of conventional THA. Annual savings of 7,8 12,9 million result from the significantly shorter hospital stay. The savings potential for rehabilitation costs is 10,5 17,5 million annually. In addition, the productivity loss for the economy is lowered by 23.8 39.7 million annually. According to this economic study we recommend the introduction of MIS techniques in THA. MIS THA surgical techniques may allow the reduction of healthcare costs. Despite the promising economic advantages of MIS THA, clinical studies are necessary to prove long-term benefits.
Hip Int 2006
PMID:Cost-benefit analysis of MIS THA: Model-based analysis of the consequences for Switzerland. 1921 30

Hip geometry abnormalities found in patients with hereditary multiple exostoses (HME) could promote premature hip joint degeneration which needs treatment. We report the case of a 45-year old male with right hip arthrosis who underwent two-incision minimally invasive (MIS-2) total hip arthroplasty (THA), with satisfactory outcome. This technique could be an alternative approach for performing THA in patients with hereditary multiple exostoses.
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PMID:Minimally Invasive Total Hip Arthroplasty in a Patient with Hereditary Multiple Exostoses: A Case Report. 3055 49


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