scholarly journals Time efficiency of direct anterior hip arthroplasty compared to postero-lateral approach in elderly patients

2021 ◽  
Vol 17 (1) ◽  
pp. 106-112
Author(s):  
Paweł Skowronek ◽  
Artur Wojciechowski ◽  
Krzysztof Wypniewski ◽  
Marcin Sibiński ◽  
Michał Polguj ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Elderly Patients ◽  
Hip Joint ◽  
Direct Anterior Approach ◽  
Lateral Approach ◽  
Primary Arthroplasty ◽  
Total Arthroplasty ◽  
The Mean ◽  
Time Required ◽  
Arthroplasty Procedure

IntroductionPrimary arthroplasty of the hip joint is currently one of the most commonly performed procedures in orthopedics. In Poland we are observing significant changes in the age structure. With the prolonged life more and more elderly patients require musculoskeletal surgery to maintain comfortable and painless mobility. Reducing the duration of the procedure reduces the costs of anesthesiology, surgical and instrument teams, as well as the operating room technical team. The aim of the study was to compare the time required to perform hip joint arthroplasty by the direct anterior approach (DAA) with the postero-lateral approach (PLA) in our hospital.Material and methodsA retrospective analysis of 559 total and bipolar cemented and cementless hip replacement procedures based on two operative approaches – the minimally invasive DAA over the course of 2 years, and the standard PLA over the course of 3 years – was performed.ResultsStatistically significant differences were observed between the approaches used for cementless total arthroplasty with regard to the mean treatment times: 51.9 min for the 272 DAA cases, and 78.3 min for the 190 PLA cases (p < 0.0001). For the cementless hemi-arthroplasty procedure, the mean treatment times were 46.9 min in 36 patients for DAA, and 48.2 min for 61 patients for PLA (p = 0.57).ConclusionsMinimally invasive DAA significantly shortens the time of the procedure in elderly patients compared to PLA. Further study is needed to analyze other aspects of those two approaches.

scholarly journals Process optimized minimally invasive total hip replacement

2012 ◽  
Vol 3 (2) ◽  
pp. 3 ◽  
Author(s):  
Philipp Gebel ◽  
Markus Oszwald ◽  
Bernd Ishaque ◽  
Gaffar Ahmed ◽  
Recha Blessing ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Direct Anterior Approach ◽  
Operation Technique ◽  
Complication Rates ◽  
Leg Length ◽  
Total Hip ◽  
The Mean ◽  
Mean Time

The purpose of this study was to analyse a new concept of using the the minimally invasive direct anterior approach (DAA) in total hip replacement (THR) in combination with the leg positioner (Rotex- Table) and a modified retractor system (Condor). We evaluated retrospectively the first 100 primary THR operated with the new concept between 2009 and 2010, regarding operation data, radiological and clinical outcome (HOOS). All surgeries were perfomed in a standardized operation technique including navigation. The average age of the patients was 68 years (37 to 92 years), with a mean BMI of 26.5 (17 to 43). The mean time of surgery was 80 min. (55 to 130 min). The blood loss showed an average of 511.5 mL (200 to 1000 mL). No intra-operative complications occurred. The postoperative complication rate was 6%. The HOOS increased from 43 points pre-operatively to 90 (max 100 points) 3 months after surgery. The radiological analysis showed an average cup inclination of 43° and a leg length discrepancy in a range of +/- 5 mm in 99%. The presented technique led to excellent clinic results, showed low complication rates and allowed correct implant positions although manpower was saved.

scholarly journals Minimally Invasive TLIF Using Unilateral Approach and Single Cage at Single Level in Patients over 65

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Hyeong-Jin Lee ◽  
Jin-Sung Kim ◽  
Kyeong-Sik Ryu
Keyword(s):  
Minimally Invasive ◽  
Elderly Patients ◽  
Rating Scale ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Fusion Rate ◽  
Leg Pain ◽  
Spinal Diseases ◽  
Single Cage ◽  
Unilateral Approach ◽  
The Mean

Background. Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a widely accepted surgical procedure. But there are only a few reports of MIS-TLIF using the unilateral approach and single cage in elderly patients. Objective. The study investigated the clinical and radiological outcomes of MIS-TLIF using the unilateral approach and single cage in the patients over 65 years of age. Methods. Thirty-eight patients were followed for a mean of 15.5±11.61 months. Radiological data include fusion rate, change of disc height, and central canal area. The numeric rating scale (NRS) and Oswestry disability index (ODI) were used to assess clinical outcomes. Results. The mean age of these patients at operation was 71.82±4.71 years (range, 65–82 years). Evidence of fusion was observed radiologically in 64.71% at 6 months and 87.5% at 12 months after surgery, giving a final fusion rate of 100%. The mean NRS scores for back and leg pain and ODI scores improved significantly at the final follow-up. Conclusions. Clinical and radiologic outcomes of MIS-TLIF using unilateral approach and single cage in elderly patients indicate an acceptable method for the treatment of various kinds of lumbar spinal diseases.

scholarly journals Minimally invasive lateral interbody fusion for the treatment of rostral adjacent-segment lumbar degenerative stenosis without supplemental pedicle screw fixation

2014 ◽  
Vol 21 (6) ◽  
pp. 861-866 ◽  
Author(s):  
Michael Y. Wang ◽  
Ram Vasudevan ◽  
Stefan A. Mindea
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Ct Scanning ◽  
Lateral Approach ◽  
Leg Pain ◽  
Adjacent Segment ◽  
Lateral Interbody Fusion ◽  
The Mean ◽  
Lateral Interbody

Object Adjacent-segment degeneration and stenosis are common in patients who have undergone previous lumbar fusion. Treatment typically involves a revision posterior approach, which requires management of postoperative scar tissue and previously implanted instrumentation. A minimally invasive lateral approach allows the surgeon to potentially reduce the risk of these hazards. The technique relies on indirect decompression to treat central and foraminal stenosis and placement of a graft with a large surface area to promote robust fusion and stability in concert with the surrounding tensioned ligaments. The goal in this study was to determine if lateral interbody fusion without supplemental pedicle screws is effective in treating adjacent-segment disease. Methods For a 30-month study period at two institutions, the authors obtained all cases of lumbar fusion with new back and leg pain due to adjacent-segment stenosis and spondylosis failing conservative measures. All patients had undergone minimally invasive lateral interbody fusion from the side of greater leg pain without supplemental pedicle screw fixation. Patients were excluded from the study if they had undergone surgery for a nondegenerative etiology such as infection or trauma. They were also excluded if the intervention involved supplemental posterior instrumented fusion with transpedicular screws. Postoperative metrics included numeric pain scale (NPS) scores for leg and back pain. All patients underwent dynamic radiographs and CT scanning to assess stability and fusion after surgery. Results During the 30-month study period, 21 patients (43% female) were successfully treated using minimally invasive lateral interbody fusion without the need for subsequent posterior transpedicular fixation. The mean patient age was 61 years (range 37–87 years). Four patients had two adjacent levels fused, while the remainder had single-level surgery. All patients underwent surgery without conversion to a traditional open technique, and recombinant human bone morphogenetic protein–2 was used in the interbody space in all cases. The mean follow-up was 23.6 months. The mean operative time was 86 minutes, and the mean blood loss was 93 ml. There were no major intraoperative complications, but one patient underwent subsequent direct decompression in a delayed fashion. The leg pain NPS score improved from a mean of 6.3 to 1.9 (p < 0.01), and the back pain NPS score improved from a mean of 7.5 to 2.9 (p < 0.01). Intervertebral settling averaged 1.7 mm. All patients had bridging bone on CT scanning at the last follow-up, indicating solid bony fusion. Conclusions Adjacent-segment stenosis and spondylosis can be treated with a number of different operative techniques. Lateral interbody fusion provides an attractive alternative with reduced blood loss and complications, as there is no need to re-explore a previous laminectomy site. In this limited series a minimally invasive lateral approach provided high fusion rates when performed with osteobiological adjuvants.

Extraforaminal compression of the L-5 nerve root at the lumbosacral junction: clinical analysis, decompression technique, and outcome

2014 ◽  
Vol 20 (4) ◽  
pp. 371-379 ◽  
Author(s):  
Seungcheol Lee ◽  
Ji Hoon Kang ◽  
Umesh Srikantha ◽  
Il-Tae Jang ◽  
Sung-Hun Oh
Keyword(s):  
Clinical Outcome ◽  
Minimally Invasive ◽  
Clinical Results ◽  
Lateral Approach ◽  
Foraminal Stenosis ◽  
Imaging Features ◽  
Adjacent Level ◽  
Far Lateral Approach ◽  
Far Lateral ◽  
The Mean

Object Extraforaminal compression of the L-5 nerve encompasses multiple pathological entities and may result from disc herniations as well as bony (osteophytes or sacral ala) or ligamentous (sacroiliac ligament and lumbosacral band) compression. Several other factors, such as disc space collapse or coronal wedging, can also contribute to narrowing of the extraforaminal space. The extraforaminal space at L5–S1 has unique anatomical features compared with the upper lumbar levels, which makes surgical access to this region difficult. Minimally invasive techniques offer easier access to the region. The purpose of this study was to analyze the contributing factors for extraforaminal compression of the L-5 nerve and assess clinical outcome following surgical decompression. Methods Fifty-two consecutive patients who underwent a minimally invasive far-lateral approach for extraforaminal compression of the L-5 nerve were retrospectively analyzed for clinical data, outcomes, and imaging features (type of disc prolapse, coronal wedging, degree of disc and facet degeneration, facet tropism, foraminal stenosis, osteophytes, and adjacent-level disease). The authors describe the surgical technique used in this study. Results The mean age of the patient sample was 57 years. Sixteen patients each had an extraforaminal ruptured disc or contained protrusion, and the remaining 20 patients had disc protrusions extending into the foraminal region or the lateral recess. Associated foraminal stenosis was found in 38.5%, and adjacent-level stenosis was noted in 22 cases (42.3%) and spondylolisthesis in 4 (7.7%). Osteophytes were noted in 18 cases. A coronal wedging angle ≥ 3° was found in 46.2%, and the laterality of wedging corresponded to the symptomatic side in 91% of cases. Fifteen patients (28.8%) complained of postoperative dysesthesias, which completely resolved in all cases within 6 months. The incidence of dysesthesias was more common in the ruptured disc group. There were no differences in clinical outcome among the different types of disc prolapses. The mean preoperative and postoperative visual analog scale scores were 7.6 and 3.6, respectively. The mean preoperative and postoperative Japanese Orthopaedic Association (JOA) scores were 6.4 and 13.8, respectively. The mean JOA recovery rate was 86.1%. According to the Macnab functional grading system, 96% of the patients had excellent or good grades at follow-up. Conclusions A minimally invasive far-lateral approach to L5–S1 requires a good understanding of the regional anatomy and can provide good to excellent clinical results in properly selected cases. This approach is effective in decompressing the far-lateral and foraminal zones. Adequate preoperative diagnosis and tailoring the surgical procedure to address the relevant compressive element in each case is essential to achieving good clinical results.

scholarly journals Evaluation of Functional Outcomes and Quality of Life in Elderly Patients (>75 y.o.) Undergoing Minimally Invasive Radical Cystectomy with Single Stoma Ureterocutaneostomy vs. Bricker Intracorporeal Ileal Conduit Urinary Diversion

2021 ◽  
Vol 11 (1) ◽  
pp. 136
Author(s):  
Andrea Fuschi ◽  
Yazan Al Salhi ◽  
Manfredi Bruno Sequi ◽  
Gennaro Velotti ◽  
Alessia Martoccia ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Minimally Invasive ◽  
Elderly Patients ◽  
Radical Cystectomy ◽  
Ileal Conduit ◽  
Elderly Subjects ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Diversion after radical cystectomy (RC) is crucial when considering elderly subjects. Data on the quality of life (QoL) impact with different diversions is scarce. This study aims to compare complications and QoL in patients aged > 75 y.o., who underwent minimally invasive (MI) RC with Bricker intracorporeal urinary derivation and single stoma ureterocutaneostomy. Methods: We conducted a retrospective analysis of elderly patients who underwent MIRC and intracorporeal diversion. The 78 subjects were divided into two groups: group A, ileal conduit, and group B, single stoma ureterocutaneostomy. We evaluated the bowel’s recovery time and complications rate. We investigated QoL 3 and 6 months after surgery using the Stoma-QoL questionnaire. Results: Mean age was 77.2 in group A and 82.4 in group B. The mean ASA score and Charlson Comorbidity index were comparable between the two groups. Rates of complications were 57.6% and 37.4% in groups A and B, respectively. The mean postoperative Stoma-QoL score 3 months after surgery was 52.2 and 52.4 in groups A and B, respectively. At 6 months of follow-up the Stoma QoL mean score was 63.4, showing homogeneity between the groups. Conclusion: MIRC with single stoma ureterocutaneostomy represents an alternative to ileal conduit, with comparable QoL and ostomy management 6 months after surgery, reporting fewer complications.

scholarly journals Injury to the Lateral Femoral Cutaneous Nerve During Minimally Invasive Hip Surgery: A Cadaver Study

2008 ◽  
Vol 90 (3) ◽  
pp. 216-220 ◽  
Author(s):  
Simon S Jameson ◽  
Daniel WJ Howcroft ◽  
Andrew W McCaskie ◽  
Craig H Gerrand
Keyword(s):  
Minimally Invasive ◽  
Cadaver Study ◽  
Skin Incision ◽  
Lateral Approach ◽  
Mean Difference ◽  
Cutaneous Nerve ◽  
Lateral Femoral Cutaneous Nerve ◽  
Femoral Cutaneous Nerve ◽  
The Mean ◽  
Tissue Trauma

INTRODUCTION A smaller skin incision as part of minimally invasive surgery (MIS) for total hip arthroplasty (THA) is thought to reduce local tissue trauma. Preservation of cutaneous nerves may reduce postoperative pain and improve rehabilitation. The standard lateral approach (SLA) and two MIS approaches (anterolateral [ALA] and posterior [PA]) were compared to determine which incision preserved cutaneous nerves. PATIENTS AND METHODS Fifteen cadaveric hip specimens were dissected to establish the course of branches of the lateral femoral cutaneous nerve. The number of branches divided by each of the three incisions was recorded. RESULTS The MIS incisions resulted in significantly less nerve division compared with the SLA. The mean difference between the SLA and the ALA was 4.4 (P < 0.0001), and between the SLA and the PA was 1.4 (P = 0.0005). The ALA divided significantly fewer nerves compared with the PA (mean difference = 3; P = 0.0001). DISCUSSION There is little evidence of the benefit of one MIS approach over another in the literature. The ALA preserved significantly more cutaneous nerves in this study. These results need corroboration with clinical outcomes to determine their significance.

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