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Minimalinvasiver Zugang zum Hüftgelenk (OCM) zur Implantation von Hüftendoprothesen

Minimally Invasive Anterolateral Approach for Total Hip Replacement (OCM Technique)

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Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Zusammenfassung

Operationsziel

Verringerung des Operationstraumas bei Implantation künstlicher Hüftgelenke. Raschere Mobilisation und kürzere Rehabilitationszeit im Vergleich zu herkömmlichen Operationstechniken. Keine Einschränkungen der Exposition von Femur und Azetabulum.

Indikationen

Primäre endoprothetische Versorgung des Hüftgelenks. Mit Erfahrung auch bei Revisionen anwendbar.

Kontraindikationen

Keine.

Operationstechnik

Stabile Seitenlage des Patienten, Beckenfixierung, Bein der zu operierenden Seite auf gynäkologischem Beinhalter gelagert. Die Beinauflage am Operationstisch ist zu halbieren. Die rückwärtige Hälfte wird entfernt. Hautschnitt über dem anterioren Anteil des Trochanter major leicht schräg im Verlauf des Septum intermusculare von Musculus gluteus medius und Musculus tensor fasciae latae. Stumpfe Präparation des muskulären Intervalls von distal. Kapseldarstellung und -inzision. Zur Schenkelhalsosteotomie Bein in Außenrotation und Hyperextension. Doppelosteotomie. Zur Azetabulumpräparation erneut Lagerung des Beins auf Beinhalter. Pfannenpräparation und -implantation. Zur Femurpräparation und Schaftimplantation Bein in Außenrotation, Hyperextension und Adduktion. Kapselrelease am Trochanter. Femurvorbereitung und Schaftimplantation. Kapselverschluss. Wundverschluss.

Weiterbehandlung

Frühe Mobilisation. Krankengymnastisch-physikalische Behandlung, Lymphdrainage. Belastung entsprechend Toleranz, bei Schmerzfreiheit auch frühe Vollbelastung erlaubt. Thromboseprophylaxe für mindestens 3 Wochen postoperativ.

Ergebnisse

Erste Implantationen mit dieser Technik erfolgten im März 2003. Mit zunehmender Erfahrung wurde dann ab August 2003 diese Zugangstechnik bei allen an der eigenen Klinik vorgenommenen Primärimplantationen angewandt. Im nächsten Entwicklungsschritt wurden routinemäßig auch alle Revisionen mit dieser Patientenlagerung und intraoperativen Beinführung durchgeführt. Die mittlerweile vorliegenden Studien weisen für die beschriebene minimalinvasive Operationstechnik im Vergleich zu herkömmlichen Techniken deutlich verbesserte Ergebnisse hinsichtlich Operationsdauer, Blutverlust, Analgetikaverbrauch, Rehabilitationszeit und Funktion auf. Eine Erhöhung der Operationsrisiken oder der Komplikationsrate wurde nicht festgestellt.

Abstract

Objective

Hip replacement with reduction of operative trauma. Thereby earlier mobilization and faster rehabilitation time compared with conventional techniques. No restrictions with regard to exposure of femur and acetabulum.

Indications

Primary total hip arthroplasty. With experience also applicable in revisions.

Contraindications

None.

Surgical Technique

Patient in lateral position with fixed pelvis. Leg support for the leg being operated and modified leg support for the contralateral side on the operating table. Special retractors and instruments are advisable. Skin incision over the anterior portion of the greater trochanter slightly curved then over the muscular interval between gluteus medius and tensor fasciae latae. Fascia incision. Preparation of anterolateral muscular interval. Exposure and incision of capsule. Leg positioning for neck osteotomy in external rotation and hyperextension. For preparation of acetabulum leg again on support. Preparation of acetabulum and cup implantation. For femoral preparation leg in external rotation, hyperextension, and adduction. Capsular release nearby greater trochanter. Capsular release and stem implantation. Repositioning. Capsule and wound closure.

Postoperative Management

Early mobilization. Physical therapy and lymph drainage. Loading of the leg according to tolerance; if patient is pain-free, full weight bearing allowed. Thrombosis prophylaxis for at least 3 weeks postoperatively.

Results

Currently, the experience comprises over 3,500 patients operated on using the minimally invasive anterolateral approach since March 2003. Restrictions regarding indications are not known. In experienced hands, the technique can even be used for revision surgery. The clinical results show significant differences with improved clinical results as compared to patients after standard approaches, especially in terms of skin-to-skin time, blood loss, use of analgesics, rehabilitation time, and functional outcome. The accuracy of implant placement is not compromised. After a fundamental learning curve, there is no evidence of increased complications.

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Authors and Affiliations

  1. German Orthopaedic Hospital W.L.L., Königreich Bahrain, Germany

    Heinz Röttinger

  2. CEO and Medical Director, German Orthopaedic Hospital W.L.L., PO Box 249, Königreich Bahrain, Germany

    Heinz Röttinger

Authors
  1. Heinz Röttinger
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Correspondence to Heinz Röttinger.

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Zeichner: Reinhold Henkel, Heidelberg

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Röttinger, H. Minimalinvasiver Zugang zum Hüftgelenk (OCM) zur Implantation von Hüftendoprothesen. Orthop Traumatol 22, 421–430 (2010). https://doi.org/10.1007/s00064-010-8035-8

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  • DOI: https://doi.org/10.1007/s00064-010-8035-8

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