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Frühere Erstmobilisation durch minimalinvasive Implantation zementierter Hüfthemiprothesen

Earlier postoperative mobilization with minimally invasive hip hemiarthroplasty

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Zusammenfassung

Die Versorgung medialer Oberschenkelhalsfrakturen mit zementierten Hemiprothesen (HEP) ist ein etabliertes Verfahren bei älteren Patienten. Wesentliche Probleme sind postoperativ die weichteil- und immobilisationsassoziierten Komplikationen.

Ziel dieser Studie war es, klinische und radiologische Ergebnisse bei minimalinvasivem anteriorem (MIS) mit denen nach transglutealem (TG) Zugang (nach Bauer et al.) zur Implantation von HEP zu vergleichen. In einer retrospektiven Studie wurden die Ergebnisse von 55 MIS- denen von 54 TG-implantierten HEP gegenübergestellt. Der Zeitpunkt der Mobilisierung, die Dauer der i.v.-Schmerztherapie und postoperative Komplikationen wurden erfasst. Radiologisch analysierten wir das femorale Offset, die Beinlänge und das femorale Alignement. Die MIS-Gruppe konnte früher mobilisiert werden (MIS am 2. vs. TG am 4. postoperativen Tag, p <0,01), die Dauer der i.v.-Schmerztherapie war jedoch verlängert (MIS 4,4 vs. TG 3,5 postoperative Tage, p=0,04). In der MIS-Gruppe traten weniger perioperative Komplikationen auf (MIS 7 vs. TG 17%, p <0,05).

Die frühfunktionellen Vorteile minimalinvasiven Operierens sind auch innerhalb eines älteren Patientenkollektivs nach Implantation einer zementierten HEP deutlich.

Abstract

Treatment of medial femoral fractures in elderly patients with cemented hip hemiarthroplasty (HEP) is a widely established procedure. The main problems with this procedure are complications associated with soft tissue damage and prolonged immobilization.

The aim of this study was to compare the clinical and radiological results after HEP implantation using either an anterior minimally invasive (MIS) approach or a regular transgluteal (TG) approach. In this retrospective study the results of 55 consecutive MIS and 54 consecutive TG approaches for implanted HEP after medial femoral fracture were compared. The time of successful mobilization, duration of the i.v. analgesia as well as the occurrence of any perioperative complications were recorded. The femoral offset, leg length and the femoral alignment were analyzed radiologically. The MIS group could be mobilized earlier (MIS 2. pod vs. TG 4. pod, p <0.01) but the need for i.v. applied analgesia was prolonged (MIS 4.4 pod vs. TG 3.5 pod, p=0.04). In the MIS group the number of perioperative complications was less than in the TG group (MIS 7% vs. TG 17%, p <0.05).

The early functional advantages of MIS after HEP implantation for medial femoral fractures are evident also within an elderly group of patients.

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Authors and Affiliations

  1. Abteilung für Unfallchirurgie, LKH Villach, Villach, Österreich

    B. Preininger, M. Jesacher & E. Fabsits

  2. Centrum für Muskuloskelettale Chirurgie, Charité-Universitätsmedizin Berlin, Campus Charité Mitte (CCM), Charitéplatz 1, 10117, Berlin, Deutschland

    B. Preininger & T. Winkler

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  1. B. Preininger
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  2. M. Jesacher
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Correspondence to B. Preininger.

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Preininger, B., Jesacher, M., Fabsits, E. et al. Frühere Erstmobilisation durch minimalinvasive Implantation zementierter Hüfthemiprothesen. Unfallchirurg 114, 333–339 (2011). https://doi.org/10.1007/s00113-010-1773-0

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