Minimalinvasive hüftendoprothetik

Abstract

Introduction: Minimally invasive hip replacement is widely discussed. The shorter skin incision is only the most superficial of its advantages. A more important advantage is the management of soft tissue in the deeper layers, avoiding detaching the tendon insertions of the stabilizing musculature. This brings advantages for the sensorimotor function as well as for the bone mineral density of the proximal femur. Methods: Medline review using search terms "total hip replacement - minimally invasive," analysis of conference reports of the German colleges of Orthopaedics and Emergency Medicine, and the Academy of Orthopedic Surgeons, from 2002 to 2006. Results: A body mass index (BMI) > 30 is only rarely a contraindication for minimal invasive hip replacement (MIS). However, minimally invasive access to the hip can be technically difficult in patients with good musculature. Surgical strategies involve for example moving windows, and intermittent relaxation of the soft tissues. Occasionally, special instruments are needed. Discussion: The current literature does not allow a final judgement about the advantages and the dangers of MIS in total hip replacement. Surgeons should bear in mind, that the learning curve for MIS approaches at the hip is long, and can entail severe complications.