[Hemiarthroplasty for geriatric femoral neck fractures].
Hemiprothese bei geriatrischer Schenkelhalsfraktur.
Anterolateral approach
Bipolar hemiarthroplasty
Early mobilization
Hemiprosthesis
Hip joint
Journal
Operative Orthopadie und Traumatologie
ISSN: 1439-0981
Titre abrégé: Oper Orthop Traumatol
Pays: Germany
ID NLM: 9604937
Informations de publication
Date de publication:
Jun 2021
Jun 2021
Historique:
received:
04
10
2020
accepted:
24
12
2020
revised:
13
12
2020
pubmed:
28
5
2021
medline:
17
6
2021
entrez:
27
5
2021
Statut:
ppublish
Résumé
Restoration of pain-free joint function by implantation of a bipolar hemiarthroplasty via anterolateral approach. Elderly multimorbid patients >70 years, age >80 years, low functional demand. Infection. Relative contraindications: dysplastic hip joint. Supine position. Anterolateral approach. Incision of the iliotibial tract and entering the interval between tensor fasciae latae muscle/gluteus medius muscle. Capsulotomy. Femoral neck osteotomy. Removal of the femoral head and determination of the size of the bipolar prosthetic head. Inspection of the acetabulum. Adduction, external rotation ("figure 4" position) of the leg. Medullary preparation of the femur with rasps up to the correct level and size of the planed stem. Ensure the correct rotation of anteversion (10-15°). Trial reduction and examination of hip stability. Verification with image intensifier. Cement restrictor, jet lavage, drying the medullary canal, injection of bone cement and insertion of the prosthetic stem. Assembly/attachment of the definitive bipolar head to the stem. Reduction of the joint. Wound closure. Early mobilization and full weight bearing. Limitation of hip flexion >90°, rotation and adduction for 6 weeks. Venous thromboembolism prophylaxis. Osteoporosis evaluation and management. Clinical-radiological control (after 6 weeks, 1/3/5 years). The implantation of a cemented hemiarthroplasty using the anterolateral approach is a muscle-sparing and dislocation-safe surgical procedure with a low risk of revision, which enables early patient mobilization and a good hip joint function. OPERATIONSZIEL: Ersatz des Hüftgelenkes durch die Implantation einer bipolaren Hemiendoprothese (HEP) – anterolateraler Zugang. Geriatrietypische Multimorbidität und höheres Alter >70 Jahre, Alter >80 Jahre, geringer funktioneller Anspruch. Floride Infektion. Relative Kontraindikationen: dysplastisches Hüftgelenk. Rückenlagerung. Anterolateraler Zugang. Eröffnung des Tractus, Eingehen in das Intervall zwischen M. tensor fasciae latae/M. gluteus medius. Kapselresektion. Schenkelhalsosteotomie. Inspektion des Acetabulums. Größenbestimmung des bipolaren Prothesenkopfes. Überführung des Beines bis maximal in die 4er-Position. Darstellen der Schenkelhalsebene und Femurpräparation mit den Schaftraspeln (Antetorsion: 10–15°) bis zur geplanten Größe/Position. Probereposition. Luxationsprüfung. Bildwandlergestützte Kontrolle. Zementstopper, Jet-Lavage, Trocknung des Markraumes und Zementierung des Originalschaftes unter Beachtung der Höhe/Anteversion. Montage/Implantation des bipolaren Originalkopfes mit der gewählten Kopflänge auf den Schaftkonus. Reposition des Gelenkes. Wundverschluss. Schmerzadaptierte Vollbelastung. Beugelimitation: 90° für 6 Wochen, keine forcierte Rotation/Adduktion. Thromboseprophylaxe. Osteoporosediagnostik/-therapie. Klinisch-radiologische Kontrolle (nach 6 Wochen, 1/3/5 Jahren). Die Implantation einer zementierten bipolaren HEP über den anterolateralen Zugang ist ein muskelschonendes und luxationssicheres Operationsverfahren mit geringem Revisionsrisiko, das eine zügige Mobilisation der Patienten bei guter Funktion des Hüftgelenkes ermöglicht.
Autres résumés
Type: Publisher
(ger)
OPERATIONSZIEL: Ersatz des Hüftgelenkes durch die Implantation einer bipolaren Hemiendoprothese (HEP) – anterolateraler Zugang.
Identifiants
pubmed: 34043028
doi: 10.1007/s00064-021-00714-x
pii: 10.1007/s00064-021-00714-x
doi:
Types de publication
Journal Article
Langues
ger
Sous-ensembles de citation
IM
Pagination
245-261Références
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