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Anesthesia type have the effect of extremity length award in patients with total hip artroplasty?

Yıl 2019, Cilt: 11 Sayı: 4, 433 - 438, 01.12.2019
https://doi.org/10.21601/ortadogutipdergisi.519877

Öz

Aim: Leg length discrepancy (LLD), instability and periprosthetic infection are most common reasons patient complaint after total hip replacement (THR) surgery. Degree of soft tissue release in operating room may mislead us about LLD. The objective of this study is to report the effect of the anesthesia type on leg lengthening amount.
Material and Method: In this study, 36 primary coxarthrosis patients who underwent THR surgery in two different medical centers under different types of anesthesia during2016-2017 were enrolled retrospectively. Patients are divided into two groups. Group 1 (n:18) who underwent general anesthesia, group 2 (n:18) who underwent regional anesthesia. Distance between greater trochanter-ischial tuberocity (GT-IT) is measured radiologically for leg lengthening, umbilicus-medial malleolus distance is measured clinically for LLD. Harris hip score (HHS) is measured for functional scoring.
Results: The average follow-up time was 13 months (12-15 months). No deep infection or neurovascular damage were seen in patients. According to GT-IT distance, leg lengthening was 19.76±9.83 mm in group 1 and 3.2±3.96 in group 2 (p:0.000*). According to 12 month umbilicus-medial malleolus distance, 9 patients experienced leg lengthening (<2cm) and 9 patients had no LLD in group 1 where 3 patients experienced leg shorthening (<1cm), 5 patients experienced leg lengthening (<1cm) and 11 patients had no LLD in group 2. Average HHS was 77.17±4.4 in group 1 where 78.64±5.73 in group 2 (p:0.410). When all patients were considered 12 patients (33%) experienced 1-10 mm lengthening, 4 patients (11%) experienced 10-20 mm lengthening. HHS was 79.62 in patients with no LLD, 77.41 in 1-10 mm LLD, 75.21 in 10-20 mm LLD (p:0.140)
Conclusion: In THR surgery, leg lengthening is seen in patients whom underwent general anesthesia more than regional anesthesia patients. We think that this is because soft tissue relaxation is more significant after general anesthesia.

Kaynakça

  • Herisson O, Felden A, Hamadouche M, Anrac P, Biau DJ. Validity and Reliability of Intraoperative Radiographs to Assess Leg Length During Total Hip Arthroplasty: Correlation and Reproducibility of Anatomic Distances. J Arthroplasty. 2016; 31(12): 2784-2788. (doi: 10.1016/j.arth.2016.05.004).
  • Ranawat CS, Rodriguez JA. Functional leg-length inequality following total hip arthroplasty. J Arthroplast. 1997; 12: 359–364. (doi: 10.1016/S0883-5403(97)90190-X).
  • Hofmann AA, Skrzynski MC. Leg length inequality and nerve palsy in total hip arthroplasty: a lawyer awaits! Orthopaedics. 2000; 23: 943–4.
  • Goodman SB, Huene DS, Imrie S. Preoperative templating for the equalization of leg lengths in total hip arthroplasty. Contemp Orthop 1992; 24: 703.
  • Ranawat CS, Rao RR, Rodriguez JA, ve ark. Correction of limb-length inequality during total hip arthroplasty. J Arthroplasty 2001; 16: 715.
  • Jasty M, Webster W, Harris W. Management of limb length inequality during total hip replacement. Clin Orthop 1996; 165.
  • Austin MS, Hozack WJ, Sharkey PF, ve ark. Stability and leg length equality in total hip arthroplasty. J Arthroplasty 2003; 18(3 Suppl 1): 88.
  • Oldman M, McCartney CJ, Leung A, ve ark. A survey of ortopedic surgeons attitudes and knowlwdge regarding regional anestesia. Anesth Analog 2004; 98: 1486-90.
  • Hofmann AA, Bolognesi M, Lahav A, ve ark. Minimizing leg-length inequality in total hip arthroplasty: use of preoperative templating and an intraoperative x-ray. Am J Orthop Belle Mead NJ 2008; 37: 18.
  • Parvizi J, Sharkey PF, Bissett GA, ve ark. Surgical treatment of limb-length discrepancy following total hip arthroplasty. J Bone Joint Surg Am 2003; 85-A: 2310.
  • Turula KB, Friberg O, Lindholm TS, ve ark. Leg lengt inequality after total hip arthroplasty. Clin Orthop Relat Res 1986: 163.
  • Mahmood SS, Mukka SS, Crnalic ve ark. The Influence of Leg Length Discrepancy after Total Hip Arthroplasty on Function and Quality of Life: A Prospective Cohort Study. The Journal of Arthroplasty 2015; 1638–1642. (doi: 10.1016/j.arth.2015.04.012).
  • Edeen J, Sharkey PF, Alexander AH. Clinical significance of leg-length inequality after total hip arthroplasty. Am J Orthop Belle Mead NJ 1995; 24: 347.
  • Sobiech M, Jabłonski M, Gorzelak M, ve ark. Postoperative limb lengthening following total hip arthroplasty (THA) through a posterior approachea challenge for the orthopaedist or physiotherapist? Ortop Traumatol Rehabil 2010; 12: 420.
  • Wylde V, Whitehouse SL, Taylor AH, ve ark. Prevalence and functional impact of patient perceived leg length discrepancy after hip replacement. Int Orthop 2009; 33: 905
  • O’Brien S, Kernohan G, Fitzpatrick C, ve ark. Perception of imposed leg length inequality in normal subjects. Hip Int 2010; 20(4): 505.
  • Benedetti MG, Catani F, Benedetti E, ve ark. To what extent does leg length discrepancy impair motor activity in patients after total hip arthroplasty? Int Orthop 2010; 34(8): 1115.
  • Gurney B, Mermier C, Robergs R, ve ark. Effects of limb-length discrepancy on gait economy and lower-extremity muscle activity in older adults. J Bone Joint Surg Am 2001; 83-A(6): 907
  • Rodgers A, Walker N, Schug S. Reduction of postoperative mortality and morbidity with epidural or spinal spinal anesthesia: Results fromoverview of randomised trials. BMJ 2000; 321: 1493
  • Keith I. Anestesia and blood loss in total hip replacement Anestesia 197; 32: 444-50.
  • Standl T, Eckert S, Schulteam Esch J. Postoperative complaints after spinal and thiopentone-isoflurane anaesthesia in patients undergoing orthopaedic surgery. Spinal versus general anaesthesia Acta Anaesthesiol Scand 1996; 40: 222.

Total kalça protezi uygulanmış hastalarda anestezi tipinin ekstremite uzunluk farkına etkisi var mı?

Yıl 2019, Cilt: 11 Sayı: 4, 433 - 438, 01.12.2019
https://doi.org/10.21601/ortadogutipdergisi.519877

Öz

Amaç: Total kalça artroplastisi sonrası ekstremite eşitsizliği, instabilite ve enfeksiyondan sonrası en sık hasta şikayet nedenidir. Kullanılan anestezi yöntemine göre yumuşak doku gevşemesindeki değişkenlik bacak uzunluk eşitsizliği konusunda bizi yanıltabilir. Çalışmamızda total kalça protezi ameliyatında anestezi tipinin bacak uzuma miktarına etkisini araştırdık.
Gereç ve Yöntem: Çalışmamızda 2016-2017 tarihleri arasında iki farklı merkezde ameliyat edilen ve anestezi türleri farklı olan 36 primer koksartrozlu hasta retrospektif olarak değerlendirildi. Hastalar genel anestezi uygulananlar [Grup 1 (n:18)] ve rejyonel anestezi uygulananlar [Grup 2 (n:18)] olarak ayrıldı. Hastalar radyolojik olarak trokanter minör - tuberkulum iskiadikum mesafesi (T.İ.-T.M.) ile uzama miktarı, umblicus - medial malleol ölçümü ile bacak uzunluk eşitsizliği belirlendi. Fonksiyonel değerlendirme için hastalara Harris kalça skoru yapıldı.
Bulgular: Ortalama takip süresi 13 ay (12-15 ay) idi. Vakaların hiçbirinde derin enfeksiyon ya da damar-sinir yaralanması görülmedi. T.İ.- T.M. mesafesine göre bakıldığında Grup 1’de 19,76 ± 9,83 mm Grup 2’de 3,2 ± 3,96 mm uzama gözlendi (p=0.000*). Hastaların 12. ay umblikus – medial malleol ölçümlerinde Grup 1 de 9 hastada ameliyat edilen bacakta uzama (<2cm) gözlenirken 9 hastada ekstremiteler eşit gözlendi. Grup 2 de 3 hastada kısalık (<1 cm), 5 hastada uzama (<1 cm), 11 hastada ise ekstremiteler eşit gözlendi. Grup 1’deki hastaların ortalama Harris Kalça Skorları 77,17±4,4, Grup 2’deki hastaların ise 78,64±5,73 olarak bulundu (p=0,410). Grup ayrımı gözlenmeksizin hastaları 12’sinde (%33) 1-10mm uzama, 4 ünden (%11) 10-20 mm bacak eşitsizliği görüldü. Harris kalça skorları bacak uzunluk farkı olmayan hastalarda 79,62, 1-10 mm hastalarda 77,41, 10-20 mm olan hastalarda 75,21 olarak bulundu (p=0,140).
Sonuç: Total kalça protezinde cerrahide genel anestezi uygulaması rejyonel anesteziye göre patolojik tarafta uzamaya neden olmaktadır. Bunun nedeni genel anestezinin daha çok yumuşak doku gevşemesi yapması olduğunu düşünmekteyiz.

Kaynakça

  • Herisson O, Felden A, Hamadouche M, Anrac P, Biau DJ. Validity and Reliability of Intraoperative Radiographs to Assess Leg Length During Total Hip Arthroplasty: Correlation and Reproducibility of Anatomic Distances. J Arthroplasty. 2016; 31(12): 2784-2788. (doi: 10.1016/j.arth.2016.05.004).
  • Ranawat CS, Rodriguez JA. Functional leg-length inequality following total hip arthroplasty. J Arthroplast. 1997; 12: 359–364. (doi: 10.1016/S0883-5403(97)90190-X).
  • Hofmann AA, Skrzynski MC. Leg length inequality and nerve palsy in total hip arthroplasty: a lawyer awaits! Orthopaedics. 2000; 23: 943–4.
  • Goodman SB, Huene DS, Imrie S. Preoperative templating for the equalization of leg lengths in total hip arthroplasty. Contemp Orthop 1992; 24: 703.
  • Ranawat CS, Rao RR, Rodriguez JA, ve ark. Correction of limb-length inequality during total hip arthroplasty. J Arthroplasty 2001; 16: 715.
  • Jasty M, Webster W, Harris W. Management of limb length inequality during total hip replacement. Clin Orthop 1996; 165.
  • Austin MS, Hozack WJ, Sharkey PF, ve ark. Stability and leg length equality in total hip arthroplasty. J Arthroplasty 2003; 18(3 Suppl 1): 88.
  • Oldman M, McCartney CJ, Leung A, ve ark. A survey of ortopedic surgeons attitudes and knowlwdge regarding regional anestesia. Anesth Analog 2004; 98: 1486-90.
  • Hofmann AA, Bolognesi M, Lahav A, ve ark. Minimizing leg-length inequality in total hip arthroplasty: use of preoperative templating and an intraoperative x-ray. Am J Orthop Belle Mead NJ 2008; 37: 18.
  • Parvizi J, Sharkey PF, Bissett GA, ve ark. Surgical treatment of limb-length discrepancy following total hip arthroplasty. J Bone Joint Surg Am 2003; 85-A: 2310.
  • Turula KB, Friberg O, Lindholm TS, ve ark. Leg lengt inequality after total hip arthroplasty. Clin Orthop Relat Res 1986: 163.
  • Mahmood SS, Mukka SS, Crnalic ve ark. The Influence of Leg Length Discrepancy after Total Hip Arthroplasty on Function and Quality of Life: A Prospective Cohort Study. The Journal of Arthroplasty 2015; 1638–1642. (doi: 10.1016/j.arth.2015.04.012).
  • Edeen J, Sharkey PF, Alexander AH. Clinical significance of leg-length inequality after total hip arthroplasty. Am J Orthop Belle Mead NJ 1995; 24: 347.
  • Sobiech M, Jabłonski M, Gorzelak M, ve ark. Postoperative limb lengthening following total hip arthroplasty (THA) through a posterior approachea challenge for the orthopaedist or physiotherapist? Ortop Traumatol Rehabil 2010; 12: 420.
  • Wylde V, Whitehouse SL, Taylor AH, ve ark. Prevalence and functional impact of patient perceived leg length discrepancy after hip replacement. Int Orthop 2009; 33: 905
  • O’Brien S, Kernohan G, Fitzpatrick C, ve ark. Perception of imposed leg length inequality in normal subjects. Hip Int 2010; 20(4): 505.
  • Benedetti MG, Catani F, Benedetti E, ve ark. To what extent does leg length discrepancy impair motor activity in patients after total hip arthroplasty? Int Orthop 2010; 34(8): 1115.
  • Gurney B, Mermier C, Robergs R, ve ark. Effects of limb-length discrepancy on gait economy and lower-extremity muscle activity in older adults. J Bone Joint Surg Am 2001; 83-A(6): 907
  • Rodgers A, Walker N, Schug S. Reduction of postoperative mortality and morbidity with epidural or spinal spinal anesthesia: Results fromoverview of randomised trials. BMJ 2000; 321: 1493
  • Keith I. Anestesia and blood loss in total hip replacement Anestesia 197; 32: 444-50.
  • Standl T, Eckert S, Schulteam Esch J. Postoperative complaints after spinal and thiopentone-isoflurane anaesthesia in patients undergoing orthopaedic surgery. Spinal versus general anaesthesia Acta Anaesthesiol Scand 1996; 40: 222.
Toplam 21 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma makaleleri
Yazarlar

Anıl Taşkesen 0000-0003-4141-7841

Yüksel Uğur Yaradılmış 0000-0002-7606-5690

Kasım Kılıçarslan 0000-0001-7337-3332

Mehmet Asiltürk 0000-0002-1069-8743

İsmail Demirkale 0000-0001-7230-1599

Murat Altay Bu kişi benim 0000-0002-1898-3733

Yayımlanma Tarihi 1 Aralık 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 11 Sayı: 4

Kaynak Göster

Vancouver Taşkesen A, Yaradılmış YU, Kılıçarslan K, Asiltürk M, Demirkale İ, Altay M. Total kalça protezi uygulanmış hastalarda anestezi tipinin ekstremite uzunluk farkına etkisi var mı?. otd. 2019;11(4):433-8.

e-ISSN: 2548-0251

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