Authors : A. Paech , F. Renken , M. Brahm , A.P. Schulz , M. Willkomm , S. Hillbricht and Ch. Jurgens
Abstract: Minimally invasive Total Hip Arthroplasty (THA) aims at reduction of tissue damage to accelerate recovery. Less or minimally invasive approaches are more and more used in elective total hip arthroplasty. The anterior approach hereby promises optimal soft tissue preservation and a good cosmetic result. The anterior minimal-invasive approach used in his study consists of a modified Smith-Petersen-Approach. In order to reduce the morbidity rate, a standardized use of minimally invasive surgical approach has been evaluated in endoprosthetic surgery of geriatric patients. The rationale for a less invasive approach in the elderly hereby is to accelerate rehabilitation and minimize co-morbidity, a cosmetic issue is of much lesser relevance in this patient population. Aim of this study is to present first clinical results of minimal-invasive approach to the hip joint (modified Smith-Petersen-Approach) as a standard in geriatric hip fracture endoprosthesis under the aspect of morbidity and rehabilitation result. The patient collective emanated consecutively from the first 12 months after introduction of the new approach. From January 2006 until December 2006 we treated 23 patients with a fractured neck of femur. The median of age in our collective was 77 years (mean 79 years, 63-92 years). We implanted both hemi- as well as total hip endoprosthesis in geriatric patients with medial femoral neck fractures type Garden 1-4 using an anterior LISA approach, 23 endoprostheses were implanted (17 total endoprostheses and 6 bipolar prostheses). The anterior LISA approach was used in all patients; there were no cases in which we had to switch to the conventional approach. We saw three complications in our follow up (13%). The Barthel index showed an improvement from 56-75 points, there was no statistical difference in improvement in patients with bipolar compared to full endopresthesis (p>0,05). At the time of follow up 20 patients (83%) had returned into their previous social status, 3 patients had to move from sheltered housing into a nursing home. The minimally invasive endoprosthesis of fractures using an anterior approach seems to be a safe method which allows the correct implantation of acetabular and femoral shaft components as well as implantation of bipolar endoprostheses.
A. Paech , F. Renken , M. Brahm , A.P. Schulz , M. Willkomm , S. Hillbricht and Ch. Jurgens , 2007. Endoprosthetic Treatment of a Fractured Femoral Neckt by the Means of an Less Invasive Surgical Anterior Approach (LISA) . Surgery Journal, 2: 37-40.