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Muskeltrauma in der primären Hüftendoprothetik unter Berücksichtigung von Alter und BMI sowie in Abhängigkeit vom operativen Zugangsweg

Minimalinvasiver anterolateraler vs. modifizierter transglutealer Zugang

Muscle trauma in primary total hip arthroplasty depending on age, BMI, and surgical approach

Minimally invasive anterolateral versus modified direct lateral approach

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Zusammenfassung

Hintergrund

Die maximale Schonung der periartikulären Muskulatur ist für den Erfolg einer Hüftendoprothesenimplantation wesentlich. Insbesondere bei älteren und übergewichtigen Patienten wird häufig ein schlechteres funktionelles Outcome nach einer Hüfttotalendoprothesenoperation festgestellt, das vermutlich auf muskulären Ursachen basiert. Zur muskelschonenden Implantation hat sich die minimalinvasive Hüftendoprothetik in der orthopädischen Chirurgie etabliert.

Methoden

Über einen transglutealen (modifiziert direkt lateral, mDL, n=19) oder einen anterolateralen minimalinvasiven Zugangsweg (ALMI, n=20) wurde 38 Patienten, die sich prä-, 3 und 12 Monate postoperativ einer MRT-Untersuchung unterzogen, eine primäre Hüftendoprothese implantiert. Evaluiert wurden die fettige Atrophie (FA) des M. glutaeus medius in Abhängigkeit von BMI und Patientenalter sowie der Einfluss des Zugangswegs.

Ergebnisse

In der übergewichtigen Gruppe waren eine postoperativ signifikant höhere FA des M. glutaeus medius nach 3 und 12 Monaten feststellbar und im Gegensatz zur normgewichtigen Gruppe eine signifikant höhergradige FA unter Verwendung des Standardzugangs. In der älteren Patientengruppe resultierte nach 3 und 12 Monaten eine postoperativ signifikant höhere FA des M. glutaeus medius; auch hier ergab sich eine signifikant höhere Atrophie bei Verwendung des mDL-Zugangs.

Schlussfolgerung

Insbesondere bei älteren und übergewichtigen Patienten wird durch einen minimalinvasiven Zugang nachweislich das Muskeltrauma reduziert. Außerdem kommt es bei diesen Patienten zu einer wesentlich höheren postoperativen muskulären Atrophie nach Prothesenimplantation als bei entsprechend Normgewichtigen und Jüngeren. Durch die höhere Vulnerabilität und das schlechtere Regenerationsvermögen der periartikulären Muskulatur profitiert diese Patientengruppe von einem minimalinvasiven Zugang.

Abstract

Background

Maximum preservation of periarticular musculature is essential for the success of total hip arthroplasty. A poorer functional outcome often occurs following total hip arthroplasty, especially in older and overweight patients and is presumed to have a muscular basis. Minimally invasive hip endoprosthetics for muscle-preserving implantation have now become established in orthopedic surgery.

Methods

A primary hip endoprosthesis was implanted in a total of 39 patients using a transgluteal (modified direct-lateral, mDL, n=19) or anterolateral minimally invasive approach (ALMI, n=20). Magnetic resonance imaging was performed preoperatively as well as 3 and 12 months after the operation. Fatty atrophy (FA) of the gluteus medius muscle was evaluated as a function of body mass index (BMI), patient age and the influence of the access route.

Results

In the overweight group a significantly higher FA of the gluteus medius muscle was found 3 and 12 months after the operation and a significantly higher grade FA using the standard access in contrast to the normal weight group. A significantly higher FA of the gluteus medius muscle was found in the older patient group 3 and 12 months postoperation as well as a significantly higher atrophy using the mDL access.

Conclusions

Muscle trauma is demonstrably reduced using a minimally invasive access, especially in older and overweight patients. In these patients there is also a substantially higher postoperative muscular atrophy after implantation of a prosthesis than in corresponding normal weight and younger patients. The higher vulnerability and poorer capacity for regeneration of periarticular musculature means that this patient group particularly profits from a minimally invasive access route.

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Authors and Affiliations

  1. Klinik für Orthopädie, Klinik für Unfall- und Wiederherstellungschirurgie, Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Deutschland

    M. Müller, S. Tohtz & C. Perka

  2. Institut für Radiologie, Charité-Universitätsmedizin Berlin, Berlin, Deutschland

    M. Dewey & I. Springer

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  1. M. Müller
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  2. S. Tohtz
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  4. I. Springer
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  5. C. Perka
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Correspondence to M. Müller.

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Müller, M., Tohtz, S., Dewey, M. et al. Muskeltrauma in der primären Hüftendoprothetik unter Berücksichtigung von Alter und BMI sowie in Abhängigkeit vom operativen Zugangsweg. Orthopäde 40, 217–223 (2011). https://doi.org/10.1007/s00132-010-1730-1

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