Evidence PICO heup benaderingen voor THP: anterieur vs posterolateraal
-
Upload
rudolf-poolman -
Category
Health & Medicine
-
view
500 -
download
0
Transcript of Evidence PICO heup benaderingen voor THP: anterieur vs posterolateraal
Intro
• THP zeer succesvolle operatie• >90% tevreden over resultaat
• Ruim 28.000 THP jaarlijks in NL• Meest gebruikte benaderingen posterolateraal (62%), direct
lateraal (20%) en anterieur (12%)
• Optimale benadering onderwerp van discussie• Spierkracht
Anterieur vs PosterieurVoordelen• Laag luxatierisico• Weinig spierschade• Minder pijn postoperatief• Snellere revalidatie• Operatie in rugligging
Nadelen• Langere leercurve (100pt)• Meer femur fracturen• Meer bloedverlies• Langere operatieduur• Revisie benadering
Voordelen• Korte leercurve (50pt)• Bewezen goede lange termijn
resultaten• Weinig bloedverlies
Nadelen• Meer spierschade• Groter luxatierisico
PICO
• P: patiënten totale heup prothese• I: anterieure benadering• C: posterolaterale benadering• O: uitkomst (OK, functie, tevredenheid, complicaties)
Search• ("arthroplasty, replacement, hip"[MeSH Terms] OR
("arthroplasty"[All Fields] AND "replacement"[All Fields] AND "hip"[All Fields]) OR "hip replacement arthroplasty"[All Fields] OR ("total"[All Fields] AND "hip"[All Fields] AND "arthroplasty"[All Fields]) OR "total hip arthroplasty"[All Fields]) AND ((anterior[All Fields] AND approach[All Fields]) OR (posterolateral[All Fields] AND approach[All Fields]))
Resultaten• 598 studies
• Higgins et al: systematic review 2015 (2 RCT, 5 prospectief vergelijkend, 10 retrospectief vergelijkend)
Sindsdien:• Malek et al• Maratt et al• Winther et al
• 448 patients undergoing unilateral primary THA
• 265 patients (age 71, 117 male) direct anterior approach
• 183 patients (age 70, 86 male) posterior approach
• No difference in age, gender, ASA grade, BMI, the side of the operation, pre-operative Oxford Hip Score (OHS) and attendance at ‘Joint school’.
• 2147 DAA THA patients were matched with PA THA based on age, gender, BMI and ASA using data from a state joint replacement registry
In 60 patients leg press and abduction strength were evaluated 2 weeks or less preoperatively, 2 and 8 days postoperatively, and at 6-week and 3-month follow-up.
Discussion• Leercurve anterieure benadering langer• Luxatie risico gelijk• Anterieure benadering mogelijk meer femur fracturen en
meer bloedverlies• Posterieure benadering langere opname (1 dag)• Functionele uitkomst (op middel- en lange termijn) gelijk
• Beide benaderingen goede optie in ervaren handen• Placebo effect
Referenties• LROI jaarverslag 2014• Higgins BT, et al. Anterior vs. Posterior Approach for Total Hip Arthroplasty, a
Systematic Review and Meta-analysis. The Journal of Arthroplasty 30 (2015) 419–434• Malek IA, et al. A comparison between the direct anterior and posterior approaches for
total hip arthroplasty. Bone Joint J 2016;98-B:754–60.• Maratt JD, et al. No Difference in Dislocation Seen in Anterior Vs Posterior Approach
Total Hip Arthroplasty. The Journal of Arthroplasty. DOI 10.1016/j.arth.2016.02.071• Winther SB, et al. Muscular strength after total hip arthroplasty. A prospective
comparison of 3 surgical approaches. Acta Orthopaedica 2016; 87 (1): 22–28• De Anta-Díaz B, et al. No differences between direct anterior and lateral approach for
primary total hip arthroplasty related to muscle damage or functional outcome. International Orthopaedics (SICOT). DOI 10.1007/s00264-015-3108-9