Experience of Rottinger Approach (Munich) in Hip Replacement
In Ukraine annually 25,000–40,000 sick and injured people need arthroplasty. Unfortunately, annually in Ukraine there are performed 10 times less operations than the estimated number of joints replacement needed. Problem of hip replacement today is very relevant in connection because of the necessity of this surgery for the elderly people after femoral neck fractures, due to osteoarthritis and many other reasons. In modern hip arthroplasty operative technique plays an important role, namely the use of minimally invasive methods and low-traumatic manipulation. Since the beginning of the development of minimally invasive technologies in orthopedics and patients’ increasing demands in the postoperative period there appeared a fast growing need to develop new minimally invasive approaches to achieve the objectives as opposed to the existing traditional techniques. The aim is to analyze the advantages and disadvantages of mini-invasive method of Rottinger approach to total hip replacement in retrospective study of patients. Materials and methods. The study was conducted at the orthopedic department of the City Clinical Hospital N 8 in Lviv. Forty seven patients operated with traditional access (Harding) were included into a control group (20 patients with osteoarthritis, 27 with the fracture of the femoral neck) and 42 patients undergone surgery with Rottinger approach were included into the basic group (20 cases of coxarthrosis, 22 cases of the fracture of the femoral neck). The average age of the patients was 65 years old (50–95 years old). A survey of patients and evaluation by Harris Hip Score were conducted. Results. Analysis of the effectiveness of arthroplasty by Rottinger approach compared to the traditional method included the intraoperative and postoperative criteria. The characteristics were compared in the postoperative period and after 2 months. For evaluation by Harris Hip Score the following parameters were taken: the painful feelings when bearing load on the operated limb, the ability to walk for different distances (unlimited, 30 minutes, 15 minutes, only indoors, impossible), the opportunity to wear socks or shoes, use stairs with no assistance, ability to perform daily activities and work, the need to use aids, limping, the ability to use public transport, sitting, operated joint mobility (in degrees). Grading by Harris Hip Score: < 70 — poor, 71–79 — fair, 80–89 — good, > 90 — excellent. The overall result for the Harris Hip Score using Rottinger approach was 89.1 points, that fitted with a good estimation, with Harding method — 72.8 (fair). When comparing the investigated approaches in dynamics the results by Harris Hip Score were significantly different in the early postoperative period. After 6 weeks after surgery score for Rottinger approach was 95.3 points (excellent), Harding method — 82.4 points (good). Evaluation results of late postoperative period came close to the best results with Rottinger approach. Conclusions. Cosmetic effect: in Rottinger approach the length of incision was 8–10cm, without myotomy and violation of the fascia lata integrity, better visualization of the acetabulum, but worse visualization of the proximal femur; specific tools were needed. This operating technique provides a shorter period of hospitalization, reduces the needs for rehabilitation and support aids, reduces the risk of complications from prolonged immobilization, and the risk of dislocation by 4.15 %.
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