VARAUS JA LIIKERAJOITUKSET LONKAN TEKONIVELLEIKKAUKSEN JÄLKEEN

Transkriptio

1 JARI SYRJÄNEN, ORTOPEDI ORTON OY, TEKONIVELOSASTO VARAUS JA LIIKERAJOITUKSET LONKAN TEKONIVELLEIKKAUKSEN JÄLKEEN

2 Sidonnaisuudet Smith & Nephew Zimmer Stryker Biomet DePuy

3 Historiaa Perinteenä ollut rajoiuaa Varausta 6 vkoa- 3 kk Fleksiorajoitus 90 6 vkoa - 2 kk Sisäkierto- tai ulkokiertorajoitus viillosta riippuen Ak[ivinen abduk[orajoitus Hardingen viillon yhteydessä

4 Miksi rajoiteuu? Estetään semen[uömien komponen`en migraa[o ja siten parannetaan niiden osteointegraa[ota Vähennetään varhaista luksaa[oriskiä Kudokset paranevat paremmin ja saavutetaan parempi funk[o

5 VaikuUaako varaus osseointegraa[oon? Wolf O, MaUsson P, Milbrink J, Larsson S, Mallmin H. The effects of different weight- bearing regimes on press- fit cup stability: a randomised study with five years of follow- up using radiostereometry. Interna[onal orthopaedics. 2012;36(4): no adverse effects of immediate weight bearing aker THA in rela[on to stability of these press- fit cups. Early mobilisa[on might have other advantages (19+18) Rhyu KH, Lee SM, Chun YS, et al. Does osteoporosis increase early subsidence of cementless double- tapered femoral stem in hip arthroplasty? The Journal of arthroplasty. 2012;27(7): even in osteoporo[c proximal femurs, press- fit fixa[on of double- tapered stems for hip arthroplasty can be safe and effec[ve without excessive early subsidence (40+40) Dalury DF, Kelley TC, Adams MJ. Modern proximally tapered uncemented stems can be safely used in Dorr type C femoral bone. The Journal of arthroplasty. 2012;27(6): modern proximally tapered stems can be used with early weight bearing in pa[ents with type C bone (60)

6 Vapaa liike- luksoituuko? Peak EL, Parvizi J, Ciminiello M, et al. The role of pa[ent restric[ons in reducing the prevalence of early disloca[on following total hip arthroplasty. A randomized, prospec[ve study. The Journal of bone and joint surgery American volume. 2005;87(2): Total hip arthroplasty through an anterolateral approach is likely to be associated with a low disloca[on rate. Removal of several restric[ons did not increase the prevalence of disloca[on following primary hip arthroplasty at our ins[tu[on. Husted H, Gromov K, Malchau H, et al. Tradi[ons and myths in hip and knee arthroplasty. Acta orthopaedica. 2014:1-8. There is no evidence having restric[ons aker THA We present evidence suppor[ng early mobiliza[on and allowing early travel Malkani AL, Ong KL, Lau E, et al. Early- and late- term disloca[on risk aker primary hip arthroplasty in the Medicare popula[on. The Journal of arthroplasty. 2010;25(6 Suppl):21-5. Decrease in disloca[on risks aker primary THA seems to coincide with increasing use of larger diameter femoral heads Kostensalo I, Junnila M, Virolainen P, et al. Effect of femoral head size on risk of revision for disloca[on aker total hip arthroplasty: a popula[on- based analysis of 42,379 primary procedures from the Finnish Arthroplasty Register. Acta orthopaedica. 2013;84(4): RR 28 vs , 28 vs , 28 vs. >

7 Varaus ja kudosten paraneminen? Bernasek TL, Tha[matla NK, Levering M, Haidukewych GJ. Effect of immediate full weight bearing on abductor repair and clinical func[on aker THA through a modified Hardinge approach. Orthopedics. 2013;36(3):e No difference was observed in Harris Hip Score, limp, thigh pain, high- grade heterotopic bone, trochanteric bursi[s, or stem subsidence between groups. Restric[ng weight bearing postopera[vely to protect the Hardinge abductor repair appears unnecessary, and recovery of ac[vity is improved with immediate weight bearing. ( pot)

8 Suositus KomplisoitumaUomassa primäärissä lonkan tekonivelleikkauksessa postopera[iviset varaus- ja liikerajoiueet ovat turhia Po[laskohtaises[ pohdiuava onko kyseessä komplisoitumaton leikkaus Varhaisella vapaalla mobilisaa[olla nopeutetaan po[laan toipumista

9 KIITOS

10