Abstract
BackgroundMinimally invasive surgery is becoming increasingly common, but evidence of the advantages of the minimally invasive transpiriformis approach in total hip arthroplasty is limited. Therefore, our single-centre randomized controlled trial evaluated the benefits of this approach versus the posterolateral approach.MethodsForty-nine patients undergoing the minimally invasive transpiriformis approach and 57 patients undergoing the posterolateral approach total hip arthroplasty were analyzed. The operative time, length of hospital stay, incision length, and peri-operative data related to the surgery were recorded. In both groups, serum CRP, IL-6, HGb, Hct, MB, CK-MB, and CK levels, Harris hip scores, and VAS scores were recorded.ResultsPatients who underwent the minimally invasive transpiriformis approach had a smaller surgical incision (9.10 ± 0.94 vs. 15.56 ± 1.20 cm, P = 0.00) and shorter hospital stay (6.20 ± 1.54 vs. 12.26 ± 2.97 days, P = 0.00) than those who underwent the posterolateral approach. Serum levels of CRP, IL-6, MB, CK-MB, and CK were also lower. According to the Harris hip score, the minimally invasive transpiriformis group showed significant improvement at one week and one month after surgery.ConclusionCompared to the posterolateral approach, the minimally invasive transpiriformis approach for total hip arthroplasty provided rapid functional recovery, elicited a significantly reduced post-operative inflammatory response, and caused less muscle damage.
Highlights
Since the early 1960s [1], when the father of modern hip replacement, John Charnley, performed joint replacement surgery, artificial joint replacement has evolved and is a mature, standard orthopaedic treatment technique that can effectively restore joint function and improve the quality of life of patients [2, 3]
The disadvantages of traditional total hip arthroplasty (THA) with the posterolateral approach (PLA), such as greater trauma, more blood loss, significant pain, and a high dislocation rate [4], have led to increasing concerns regarding how to minimize the intra-operative damage to the soft tissues of the hip, which poses a new challenge to orthopaedic surgeons
The minimally invasive transpiriformis group consisted of 49 patients (16 males and 33 females) with a mean age of 71.06 ± 10.87 years; the posterolateral group consisted of 57 patients (26 males and 31 females) with a mean age of 73.93 ± 10.02 years
Summary
Since the early 1960s [1], when the father of modern hip replacement, John Charnley, performed joint replacement surgery, artificial joint replacement has evolved and is a mature, standard orthopaedic treatment technique that can effectively restore joint function and improve the quality of life of patients [2, 3]. The operative time, length of hospital stay, incision length, and peri-operative data related to the surgery were recorded In both groups, serum CRP, IL-6, HGb, Hct, MB, CK-MB, and CK levels, Harris hip scores, and VAS scores were recorded. Results Patients who underwent the minimally invasive transpiriformis approach had a smaller surgical incision (9.10 ± 0.94 vs 15.56 ± 1.20 cm, P = 0.00) and shorter hospital stay (6.20 ± 1.54 vs 12.26 ± 2.97 days, P = 0.00) than those who underwent the posterolateral approach. Conclusion Compared to the posterolateral approach, the minimally invasive transpiriformis approach for total hip arthroplasty provided rapid functional recovery, elicited a significantly reduced post-operative inflammatory response, and caused less muscle damage
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