Yale technology

The Yale technique is used in medicine to describe the 2-incision access to the hip joint for the minimally invasive implantation of a primary endoprosthesis . The decisive basic idea of ​​the “Yale” technique is the optimal view of the operating field ventrally to the socket of the hip and dorsally to the shaft of the thigh, in contrast to other methods, which e.g. T. have a limited or even only indirect view of the implantation site. In this way, the high standard of optimal prosthesis component positioning can be achieved and reliable long-term results can be expected while at the same time reducing comorbidity and shortening rehabilitation.

origin

The 2-incision access to the hip joint for the implantation of a primary endoprosthesis goes back to the work of North American orthopedic surgeons (Keggi, Irving ( Yale University ) et al.), Who combined a small distal portion of a Smith-Petersen incision with a used small dorsal gluteal moore approach . Based on this tradition, the new access is called "Yale" access. The technology was first introduced in Germany in 2004 by Robert Kipping and established at the Wolfart Clinic in Munich-Graefelfing.

Surgical technology

The principle of this approach is the excellent direct view of the anatomical "landmarks", the strict protection of the complex of the fascia lata , the tensor and the gluteus medius and minimus and thus the avoidance of postoperative hip insufficiency and painful trochanteric bursitis. In addition, the advantages generally attributed to minimally invasive approaches of significantly shortened postoperative rehabilitation, less soft tissue trauma and less blood loss are achieved. It is important that with the 2-incision method described here, complex and radiation-stressing instrumentation (image intensifier and / or navigation) can be completely dispensed with due to the excellent direct view. This clearly distinguishes this method from the 2-incision technique described by Berger / Chicago. There is now agreement that the MIV method used must be measured against the very successful standard implantation method (dorsal, anterolateral, etc.), which delivers good or excellent results in over 90%.

discussion

Proponents of the minimally invasive surgical technique for hip implantation see the 2-incision approach as a practicable standard approach.

The physically active patients of every age group, who were best able to convert the maintenance of muscle strength into mobility, benefit most from the method. The complication rate is comparable to that of the standard operation if the surgeon is trained in this method and performs a sufficient number of operations per year using this technique.

Access-related complications such as an increased risk of dislocation from the dorsal access, as well as the initially increased incidence of postoperative seromas, could be eliminated by adapting the surgical technique.

Some studies have shown that the advantage of the minimally invasive method may only be in the first 6 weeks after the operation. Here the minimally invasive treated patients are mobile faster. In an extensive study from 2014, it was possible to demonstrate with the help of objective gait analysis parameters that patients who were operated on with the approach described here can put more strain on the operated leg after three days than patients with a lateral approach. On the other hand, these patients had the greatest increase in walking speed and stride length in the first three months. The patients could therefore be fully mobilized earlier. One reason for this can be the preserved full function of the fascia lata on the outer thigh with intact proprioception without function-reducing scars. In any case, the other minimally invasive methods do not have their own lower exposure of the surgical field with the Yale technique, since both implantation sites (pelvis and femur) are visualized directly.

literature

• H. Böhm: Rehabilitation of gait in patients after total hip arthroplasty: Comparison of the minimally invasive Yale 2-incision technique and the conventional lateral approach. In: Gait & Posture. , Volume 44, 110-115 Abstract
• R. Kipping: The 2-incision approach for the implantation of a total hip endoprosthesis. In: Orthopedic Practice. 42 10, 2006, pp. 598-503.
• R. Kipping: The standardized implantation of a total hip endoprosthesis via a two-incision approach ("Yale technique"). In: Operative Orthopedics and Traumatology (OOT). 3/2009. (Abstract)
• JF Irving: Direct two-incision total hip replacement without fluoroscopy. In: Orthopedic Clinics N Am. 35, 2004, pp. 173-181.
• TP Sculco: The mini-incision hip. Current concepts in joint replacement . Dec. 11-14th, Orlando / USA Paper (2002) # 42
• RA Berger: Total hip arthroplasty using the minimally invasive two-incision approach. In: Clin Orthop. 417, 2003, pp. 232-241.
• M. Rittmeister, DP König, P. Eysel, F. Kerschbaumer: Minimally invasive approaches to the hip and knee joint for artificial joint replacement. In: Orthopedist. 33, 2004, pp. 1229-1235.

Individual evidence

1. ^ H. Böhm: Rehabilitation of gait in patients after total hip arthroplasty: Comparison of the minimally invasive Yale 2-incision technique and the conventional lateral approach. In: Gait & Posture , Volume 44, 110–115.

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