[Templating and radiological outcome monitoring for elective total hip arthroplasty. Applied quality management principles for safe patient care]. Unfallchirurg. 2011;114:776-785. [PMID: 21870133 DOI: 10.1007/s00113-011-2029-3]

Digital templating in total hip arthroplasty: Additional anteroposterior hip view increases the accuracy

AIM

To analyze planning total hip arthroplasty (THA) with an additional anteroposterior hip view may increases the accuracy of preoperative planning in THA.

METHODS

We conducted prospective digital planning in 100 consecutive patients: 50 of these procedures were planned using pelvic overview only (first group), and the other 50 procedures were planned using pelvic overview plus antero-posterior (a.p.) hip view (second group). The planning and the procedure of each patient were performed exclusively by the senior surgeon. Fifty procedures with retrospective analogues planning were used as the control group (group zero). After the procedure, the planning was compared with the eventually implanted components (cup and stem). For statistic analysis the χ² test was used for nominal variables and the t test was used for a comparison of continuous variables.

RESULTS

Preoperative planning with an additional a.p. hip view (second group) significantly increased the exact component correlation when compared to pelvic overview only (first group) for both the acetabular cup and the femoral stem (76% cup and 66% stem vs 54% cup and 32% stem). When considering planning ± 1 size, the accuracy in the second group was 96% (48 of 50 patients) for the cup and 94% for the stem (47 of 50 patients). In the analogue control group (group zero), an exact correlation was observed in only 1/3 of the cases.

CONCLUSION

Digital THA planning performed by the operating surgeon and based on additional a.p. hip view significantly increases the correlation between preoperative planning and eventual implant sizes.

[Experience in establishing a certified endoprosthesis center]

BACKGROUND

It is well known that morbidity rates of arthroplasties are inversely related to procedure volume. In the department of orthopaedics at a German medical school, a performance of certification of high-volume center for total hip and knee arthroplasties, called the EndoCert(®) Initiative, was started. This project was initiated by the German society of orthopaedic surgery (DGOOC) to secure the quality of total knee and hip arthroplasties.

OBJECTIVES

The aim of this study is to evaluate effects of certification, pathwaycontrolled therapy and quality indicators on outcome in arthroplasty three years after implentation.

MATERIALS AND METHODS

Arthroplasties performed in this certified center for total hip and knee arthroplasties were evaluated. Outcome was evaluated after the implementation of quality indicators and clinical pathways.

RESULTS

After establishment of certification in the center for total hip and knee arthroplasties morbidity rates decreased as quality increased.

CONCLUSION

The implementation of pathway-controlled therapy and quality indicators in a high-volume center for total joint arthroplasties shows better clinical results. Capital investment and efforts are legitimated.

[Nerve lesions after minimally invasive total hip arthroplasty]

Although there is no clear evidence, minimally invasive hip arthroplasty seems to be associated with slightly higher complication rates compared to standard procedures. Major nerve palsy is one of the least common but most distressing complications. The key for minimizing the incidence of nerve lesions is to analyze preoperative risk factors, accurate knowledge of the anatomy and minimally invasive techniques. Once clinical signs of nerve injury are evident, the first diagnostic steps are localization of the lesion and quantification of the damage pattern. Therefore, clinical assessment of the neurological deficits should be performed as soon as possible. Apart from rare cases of isolated transient conduction blockade or complete transection, the damage pattern is mostly combined. Thus, there can be evidence for dysfunction of nerve conduction (neuropraxia) and structural nerve damage (axonotmesis or neurotmesis) simultaneously. Because the earliest signs of denervation are detectable via electromyography after 1 week, it is not possible to make any reliable prognosis within the first days after nerve injury using electrophysiological methods. This review article should serve as a guideline for prevention, diagnostics and therapy of neural lesions in minimally invasive hip arthroplasty.