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Miércoles, 9 de abril Wednesday, 9th April CADERA / HIP Abordajes quirúrgicos: MIS y Navegación Cadera difícil y complicaciones de las artroplastias Cadera de revisión Surgical approach: MIS and Navigation Difficult hip and complications Hip revision Moderadores / Moderators: Luis López-Durán, Humbert Ferrer, Francisco Gomar, Antonio Coscujuela
MIÉRCOLES / WEDNESDAY 50 08.00 - 08.45 h CADERA / HIP Abordajes quirúrgicos: MIS y Navegación / Surgical approach: MIS and Navigation Moderador: Luis López-Durán MIS THR: WHY, HOW AND RESULTS Lawrence D. Dorr, M.D. Medical Director Arthritis, Institute Centinela Hospital, California (USA) The biggest controversy in total hip replacement (THR) in 2007 is the size of the incision for the operation. Minimally invasive surgery (MIS) exploded onto the orthopedic scene in the early 2000s. Although some surgeons, such as Keggi, 1 Sculco, 2 and Lester 3 had been performing surgery with small incisions, it was a change that was far below the radar screen. The explosion occurred when Richard Berger refined the two-incision technique and combined this with a new pain management protocol to send patients home the day of surgery. 4 There was a segment of the patient population that embraced this concept and the knowledge of this option of care spread rapidly among the lay-community until the “tipping point” was quickly passed. 5 Surgeons then began to feel pressure to provide this care to patients. Surgeons resented the fact that this change occurred “upside down,” ie, patients knew about this MIS, and wanted it, before the surgeon knew, and certainly before the surgeon knew whether it was medically effective. Popularity preceded publication! Many surgeons questioned the wisdom of making changes in an operation that was proven to improve quality of life and be of benefit to society. 6 The decade of the 1980s had seen change in fixation from cemented to noncemented, and the decade of the 1990s provided changes in the articulation surface. These changes gained acceptance (cementless fixation slowly over 15 years) because the surgeon could appreciate the contribution of the changes to better durability for the patient. In the decade of the 2000s, the surgeon has had deep reservations about changing the incision, which could possibly create more complications and more stress for the surgeon in performing the operation. On the other hand, surgeons performing these small-incision operations observed the improved optimism and recovery in their patients and quickly became advocates. The research into MIS has focused on learning why small-incision operations benefit patients. PURPOSE OF MIS Any change which occurs quickly, and without documentation, will create misunderstanding. The purpose of MIS operations is to enhance the recovery of the patient. It was recognized by those who pioneered it that it was a short-term benefit change. It achieved increased confidence in the patient in their recovery, which resulted in earlier discharge from the hospita 1,4,7 earlier return to work, 4,8 fewer assistive devices for more rapid mobilization, 4,7,8 and less pain? 7 Because the publications that documented this medical effectiveness lagged behind its community popularity, confusion among surgeons occurred. Every previous change in THR was done to prolong the durability of the operations. Many surgeons assumed this change in incision length likewise was to improve durability. Because this was not the purpose, the surgeons never did, and never will, find evidence that increased durability was possible. The short-term benefits are important to the patient and stimulate some of the underserved population for total hip and total knee replacement to seek an operation. 9 Some patients fear hospitalization because of concerns with infection and medical errors. Some patients, who are still economically productive, are fearful of loss of a job or a business with a prolonged recovery. Elderly patients will choose not to undergo surgery because they their life span against an expected long recovery. 10,11 Most patients do not want to go to a rehabilitation unit, and the ability to go home from the hospital tilts their decision to undergoing the operation because it gives them return of their independence and prevents postoperative depression. 12-14 The greatest benefit of MIS THR is that it has created a new process of THR that benefits the patient’s mental health and confidence in achieving the outcomes they envision. 15 BENEFITS OF MIS Complete success of THR requires that patients achieve relief of pain, return of function and mobility, and satisfaction. Medical effectiveness of THR is rated by scoring instruments such as Harris Hip Score 16 and SF-36, 17 which grade pain relief and functional gains. The deficiencies of these instruments are that they measure functional gains we as surgeons deem important, but not necessarily the functional activity the patient considers most important. Furthermore, we do not have a grading system for satisfaction. Hudak and co-workers 18 defined satisfaction as the patient being unselfconscious about their repaired limb (hip). In a personal communication, David Beverland of Belfast, Ireland, terms
Page 1: VI Curso Internacional de Artroplas
Page 4 and 5: LIBRO DE RESÚMENES / ABSTRACT BOOK
Page 6: El Curso Internacional de Artroplas
Page 10 and 11: Índice Ponentes Speakers Index VI
Page 12 and 13: Lawrence Dorr - MIS THR: why, how a
Page 14: Laurent Sedel - Ceramic - ceramic c
Page 17 and 18: MARTES / TUESDAY 14 09.00 - 10.45 h
Page 19 and 20: MARTES / TUESDAY 16 The results pre
Page 21 and 22: MARTES / TUESDAY 18 METAL-METAL COU
Page 23 and 24: MARTES / TUESDAY 20 METHOD Forty-on
Page 25 and 26: MARTES / TUESDAY 22 Los sistemas po
Page 29 and 30: MARTES / TUESDAY 26 interlock betwe
Page 31 and 32: MARTES / TUESDAY 28 PRÓTESIS MODUL
Page 33 and 34: MARTES / TUESDAY 30 ACETABULAR FIXA
Page 35 and 36: MARTES / TUESDAY 32 center is only
Page 37 and 38: MARTES / TUESDAY 34 mm steps and ev
Page 41 and 42: MARTES / TUESDAY 38 REFERENCES - Eb
Page 43 and 44: MARTES / TUESDAY 40 HOW SMALL CHANG
Page 45 and 46: MARTES / TUESDAY 42 HIP RESURFACING
Page 47 and 48: MARTES / TUESDAY 44 INDICATIONS AND
Page 49 and 50: MARTES / TUESDAY 46 a disturbed blo
Page 54 and 55: Notas / Notes MIÉRCOLES / WEDNESDA
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Notas / Notes MIÉRCOLES / WEDNESDA
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JUEVES / THURSDAY 106 08.30 - 10.45
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JUEVES / THURSDAY 108 component pos
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JUEVES / THURSDAY 110 Por la única
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JUEVES / THURSDAY 112 ANILLOS DE SO
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JUEVES / THURSDAY 114 múltiples pe
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JUEVES / THURSDAY 116 las 2, la got
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JUEVES / THURSDAY 118 throplasty. J
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JUEVES / THURSDAY 124 Marrow stimul
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JUEVES / THURSDAY 126 Results bette
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JUEVES / THURSDAY 128 RESULTS MCKEE
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JUEVES / THURSDAY 130 minimal erosi
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JUEVES / THURSDAY 132 Last but not
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JUEVES / THURSDAY 134 motion, absen
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JUEVES / THURSDAY 138 to numb areas
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JUEVES / THURSDAY 142 to be detrime
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JUEVES / THURSDAY 144 2. Burnett RS
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Viernes, 11 de abril Friday, 11th A
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Notas / Notes VIERNES / FRIDAY 149
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