Mini-Incision THA. What Qualifies? A Rose by Any Other Name? Todd V. Swanson, MD Las Vegas, Nevada, USA

Transcription

1 2 nd nd Annual Impact of Emerging Technology on Hip and Knee Reconstruction November 16, 2003 Mini-Incision THA Todd V. Swanson, MD Las Vegas, Nevada, USA A Rose by Any Other Name? Mini-Incision Surgery? Minimally invasive surgery (MIS )? Minimal Incision Total Hip (MITH )? Less invasive surgery (LIS) October 24, 2003 MIS THA Results 2 What Qualifies? <10 cm incision? <8 cm incision? 2 3-cm 3 incisions? More common sense approach: LIS Less Invasive Surgery Shorter incision than you are using now Less dissection / soft tissue trauma October 24, 2003 MIS THA Results 3 LIS Only recently becoming widely accepted in THA: Wounds heal from side to side, not end to end Small incision, small surgeon We don t t do peek-a-boo surgery! Why look through a keyhole when you can open the door? October 24, 2003 MIS THA Results 4 1

2 LIS now the Standard of Care: Arthroscopy (knee, shoulder, elbow, wrist, hip) Carpal tunnel release Minimally invasive spine surgery Minimally invasive fracture fixation Other specialties General surgery Urology Gynecology October 24, 2003 MIS THA Results 5 Advantages of LIS Less post-op op pain Shorter hospitalization Quicker recovery Fewer complications More surgeon efficient OR time Follow-up visits October 24, 2003 MIS THA Results 6 Literature Review of LIS THA Not much published yet in peer-reviewed reviewed journals Some presentations at meetings October 24, 2003 MIS THA Results 7 Literature Summary Keggi, 2003, 1993, 1980 Lester, Orthopedics & Traumatology,, 2001 Waldman, J South Orthop Assoc, 2002 Wenz, Orthopedics, 2002 DiGioia, J Arthroplasty, 2003 Sculco, AAOS, 2003 Swanson, AAOS, Most Advantages early 2. Long-term results similar 3. No increase in complications or component malpositioning October 24, 2003 MIS THA Results 8 2

3 2-Incision Technique 2 3-cm 3 incisions October 24, 2003 MIS THA Results 19 2-Incision Technique (Berger, AAOS, 2003) 100 patients since 2001 Fluoroscopic guidance in all Learning Curve: Hours October 24, 2003 MIS THA Results 20 (Dana Mears, MIS Meets CAOS, Pittsburgh, PA, May, 2003) (Mark Hartzband, MIS Meets CAOS, Pittsburgh, PA, May, 2003) Berger: 1/100 = 1% Others: 6/47 = 13%?? Most cases not a significant problem But some neurogenic pain, neuroma October 24, 2003 MIS THA Results 22 October 24, 2003 MIS THA Results 23 3

4 (Nick Sotereanos, MIS Meets CAOS, Pittsburgh, PA, May, 2003) 4/20 fractures (20%) 1 Dislocation 2.5 hour mean OR time Every patient gets Indocin for H.O. October 24, 2003 MIS THA Results 24 Other Issues Top Secret nature of surgical technique and protocols Requirement to do multiple Zimmer THA s s before admitted to the 2-incision club Required to sign secrecy agreement to learn 2-incision 2 technique Direct Patient Marketing October 24, 2003 MIS THA Results 29 Misinformation to Patients (Frost, brandchannel.com,, November, 2003) Tom Thornhill,, MD: October 24, 2003 MIS THA Results 31 (Mark Hartzband, MIS Meets CAOS, Pittsburgh, PA, May, 2003) No mention of surgical approach!! 1 st case of day 22 units autologous blood in PAR 33 sessions P.T. on OR day October 24, 2003 MIS THA Results 32 4

5 LIS Total Hip Replacement Not just a shortened Posterior Approach 10 cm oblique incision Non-proprietary technique Cemented or cementless prosthesis Yes LIS Standard Incision October 24, 2003 MIS THA Results 40 No 300 Pound (135 kg) Patient October 24, 2003 MIS THA Results 41 Pre-requisites requisites for LIS Proper incision placement Proper instrumentation Proper limb positioning Incision October 24, 2003 MIS THA Results 42 October 24, 2003 MIS THA Results 44 5

6 Special Instruments Inferior Acetabular Retractor Femoral Elevator Retractor Summary To date, I have performed over 1,100 posterior LIS THA s and have found the technique to be accurate, reproducible, and advantageous to both patient and surgeon. October 24, 2003 MIS THA Results 45 October 24, 2003 MIS THA Results 77 But.. Just as any new surgical technique has a learning curve, this procedure is no exception. However, once learned, it can provide substantial benefits to the patient. A Couple Words of Advice: 1. Use Common Sense 2. Don t t let marketing dictate your practice habits October 24, 2003 MIS THA Results 78 October 24, 2003 MIS THA Results 79 6