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Less invasive revision THA technique may yield lower complication rate, reduced length of stay

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Torsten Prietzel

COPENHAGEN — German researchers have developed a less invasive revision total hip arthroplasty technique they claim can be applied in 30% to 50% of cases and yields lower complication rates and reduced length of hospital stay.

Torsten Prietzel, MD, presented the findings at the 12th EFORT Congress 2011, here.

The most important modification of the technique, Prietzel said, involves reconstructing the integrity of the capsule, with a long-term increase in joint stability — and decrease in dislocation risk — being achieved through the application of a larger ball-insert pair that depends upon the outer diameter of the socket.

“We are performing revision more and more revision total hip arthroplasty with this technique,” Prietzel said. “By reducing the invasiveness of both primary and revision [total hip arthroplasty (THA)], we are able to achieve better functional outcomes, facilitate better rehabilitation and minimize risks — especially those associated with dislocation.”

Difference in technique

The new technique, Prietzel said, is different from the conventional approach in that it applies larger hip balls and inserts following the expansion of the variety of available articulating joint components in 4-mm steps, and it involves sparing and reconstructing the joint capsule.

The point in sparing and reconstructing the joint capsule, according to Prietzel, is maintaining the integrity of its acetabular origin.

For the data presented, the researchers combined their procedure with tissue dissection “strictly parallel to the direction of the muscle fibers.” From there, Prietzel said, the Bauer transgluteal approach was applied.

With an overall study period of 6.5 years, the team evaluated inpatient postoperative phases after THA and collected questionnaires completed by all patients in the cohort.

Study results

According to Prietzel, there were 55 cases in which the new, less invasive revision procedure was performed. There were no intraoperative method-specific complications — however, Prietzel reported, there was one dislocation and one early infection. Mean postoperative stay for patients of the less invasive technique was 9.5 days, compared with the average of 20.5 days for all revisions.

Prietzel noted the technique was primarily applied in isolated stem exchange followed by exchange of bearing components and complete joint exchange, but he added that it could be difficult to apply the less invasive technique to isolated socket exchange with a stable stem.

“We have improved stability … and lowered complication rate,” Prietzel concluded. “Furthermore, there has been a considerable reduction of length of stay in the hospital. Thus, the modified methods are recommended both medically and economically.”

Reference:

• Prietzel T, Farag M, Petermann M, et al. Less invasive revision total hip arthroplasty — A retrospective analysis after 55 operations. Paper #2282. Presented at the 12th EFORT Congress 2011. June 1-4. Copenhagen.

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