Experience of Rottinger approach in hip replacement

Abstract

Background: An important aspect in modern hip arthroplasty plays operative technique, namely the use of minimally invasive techniques and low-traumatic manipulation. Since the beginning of the development of minimally invasive technologies in orthopedics and increasing demands on the part of patients in the postoperative period there appeared a fast growing need to develop new minimally invasive approaches to achieve the objectives as opposed to the existing traditional techniques. Material and methods: The analysis of 47 patients operated on traditional access (Harding) – control group (20 patients with osteoarthritis, 27 with a fracture of the femoral neck) and 42 patients undergoing surgery for Rottinger approach – the main group (20 – coxarthrosis, 22 – fracture of the femoral neck). A survey of patients and evaluation of Harris Hip Score were made. Results: For evaluation of Harris Hip Score the following parameters were taken: the painful feelings when bearing load on the operated limb, the ability to walk different distances (unlimited, 30 minutes, 15 minutes, only indoors, impossible), the opportunity to wear socks or shoes, use stairs with no assistance, ability to perform daily activities and work, the need to use aids, limping, the ability to use public transport, sitting, operated joint mobility (in degrees). Grading for the Harris Hip Score: <70 – poor, 71-79 – fair, 80-89 – good, >90 – excellent. The overall result for the Harris Hip Score using Rottinger approach was 89.1 points, corresponding evaluation “good”, and Harding method – 72.8 (“fair”). 6 weeks after surgery score for Rottinger approach was 95.3 points (“excellent”), Harding method – 82.4 points (“good”). Conclusions: Cosmetic effect by Rottinger approach length of incision is 8-10cm, without myotomy and violation of the fascia lata integrity, better visualization of the acetabulum, but worse is the proximal femur, the need for specialized tools. This operating technique provides a shorter period of hospitalization, reduces the need for rehabilitation and support aids, reduces the risk of complications from prolonged immobilization, and reduces the risk of dislocation by 4.15%.