Department of Orthopedics, Trauma and Reconstructive Surgery, Philippusstift Essen, Essen Hülsmannstraße 17, 45355, Essen, Germany.
Chair of Orthopedics and Trauma Surgery, University of Duisburg - Essen, Essen, Germany.
Orthopadie (Heidelb). 2022 Dec;51(12):986-995. doi: 10.1007/s00132-022-04310-0. Epub 2022 Oct 7.
Minimally invasive approaches are subject to controversy in orthopedic surgery. The aim of the current study was to compare the radiographic parameters between two minimally invasive approaches in total hip arthroplasty.
Between January 2018 and February 2019, the radiographic parameters of 80 patients undergoing total hip arthroplasty via minimally invasive approaches (DAA: n = 40; SuperPath® SP: n = 40) have been measured. The radiographic analysis was performed with digital software tool mediCad® (HECTEC™ GmbH, Landshut, Germany).
Patients treated with DAA showed significantly higher inclination (SP: 39.7° ± 7.3° vs. DAA: 44.7° ± 5.3°) and significantly lower cup anteversion values (SP: 31.2° ± 7.9° vs. DAA: 27. 5° ± 5.3°, p < 0.001) than patients undergoing THA via SP postoperatively. The horizontal femoral offset was neither preoperatively nor postoperatively higher in DAA than in SP cohort (preoperative: p = 0.71, postoperative: p = 0.25) (preoperative: SP:37.2 mm ± 7.3 vs. DAA 38.2 mm ± 7.5; postoperative: SP: 38.0 mm ± 7.2 vs. DAA: 40.5 mm ± 7.0). At both times, the acetabular offset was significantly higher in DAA cohort than in SP cohort (preoperative: SP: 32.9 mm ± 5.9 vs. DAA: 36.8 mm ± 4.9; postoperative: SP: 28.9 mm ± 4.2 vs. DAA: 33.4 mm ± 3.8) (preoperative: 0.001; postoperative: p < 0.001). The vertical height was preoperatively and postoperatively not significantly higher in SP cohort than in DAA cohort (preoperative: SP: 16.1 mm ± 4.1 vs. DAA: 15.5 mm ± 4.9; postoperative: SP: 16.6 mm ± 4.6 vs. DAA: 16.1 mm ± 4.6) (preoperative: p = 0.77; postoperative: p = 0.58). The preoperatively existing leg length discrepancy of the affected leg could be compensated via surgery without showing significant differences between the two cohorts (preoperative: SP: -3.2 mm ± 5.4 vs. DAA: 1.9 mm ± 4.9; postoperative: SP: 1.5 mm ± 5.4 vs. DAA: 4.8 mm ± 5.6) (preoperative: p = 0.34; postoperative: p = 0.09).
The current study demonstrates suitable cup positioning and stem alignment in the coronal plane using minimal-invasive approaches DAA and Superpath®.
微创入路在矫形外科中存在争议。本研究的目的是比较两种微创入路在全髋关节置换术中的放射学参数。
2018 年 1 月至 2019 年 2 月，对 80 例行微创入路全髋关节置换术的患者（直接前路入路 DAA：n=40；SuperPath® SP：n=40）的放射学参数进行了测量。放射学分析使用数字软件工具 mediCad®（HECTEC™ GmbH，德国兰茨胡特）进行。
与接受 SP 入路治疗的患者相比，接受 DAA 治疗的患者术后髋臼杯倾斜角明显更高（SP：39.7°±7.3°vs. DAA：44.7°±5.3°），髋臼杯前倾角明显更低（SP：31.2°±7.9°vs. DAA：27.5°±5.3°，p<0.001）。DAA 组患者术后的股骨水平偏心距在前、后均未高于 SP 组（术前：p=0.71，术后：p=0.25）（术前：SP：37.2mm±7.3 vs. DAA 38.2mm±7.5；术后：SP：38.0mm±7.2 vs. DAA：40.5mm±7.0）。在两个时间点，DAA 组患者的髋臼外展角均明显高于 SP 组（术前：SP：32.9mm±5.9 vs. DAA：36.8mm±4.9；术后：SP：28.9mm±4.2 vs. DAA：33.4mm±3.8）（术前：p=0.001；术后：p<0.001）。SP 组患者术后的垂直高度在前、后均未明显高于 DAA 组（术前：SP：16.1mm±4.1 vs. DAA：15.5mm±4.9；术后：SP：16.6mm±4.6 vs. DAA：16.1mm±4.6）（术前：p=0.77；术后：p=0.58）。受影响侧术前存在的肢体长度差异可通过手术得到补偿，两组间无显著差异（术前：SP：-3.2mm±5.4 vs. DAA：1.9mm±4.9；术后：SP：1.5mm±5.4 vs. DAA：4.8mm±5.6）（术前：p=0.34；术后：p=0.09）。
本研究表明，在冠状面采用直接前路和 Superpath®微创入路可获得合适的髋臼杯位置和股骨柄对线。
