Abstract
BackgroundThe tissue sparing surgery (TSS) concept means not only smaller incisions but also less tissue disruption, allowing decreased blood loss and improved function. However, TSS techniques can result in more complications related to the learning curve. The aim of this study was to compare the learning curve of an experienced surgeon with different TSS approaches for total hip replacement (THR) from a clinical and surgical point of view, focussing especially on complications related to the use of different geometric stems.Materials and methodsSixty patients scheduled to be operated for a primary THR were enrolled in the study and were randomly assigned to surgery by one of three different TSS approaches: lateral with mini incision (group A), minimally invasive anterior (group B) and minimally invasive antero-lateral (group C). Results from the three TSS groups were compared with a control group of 149 patients (group D).ResultsOur results reveal significantly reduced blood loss in the TSS groups compared with the control group, with no differences between the TSS groups. We found better early functional scores in the two minimally invasive groups (anterior and anterolateral), and a lower rate of complications with the antero-lateral TSS approach.ConclusionThe antero-lateral TSS approach seems to be safer and less demanding than standard THR surgery, and is suitable for use with different stems.
Highlights
Since tissue sparing surgery (TSS) hip replacement was introduced, it has been greeted both with enthusiasm and concern
We have chosen the first 20 cases as the learning curve based on articles by Woolson et al [2] and Archibeck and White [3], which demonstrate a high rate of complications in minimally invasive total hip arthroplasty (THA) during a surgeon’s early experience with these methods
Group A consisted of 20 patients, 14 males and 6 females with a mean age of 66.3 years [range 74–38 years; standard deviation (SD) 10.4], a mean body mass index (BMI) of 27.6 and a mean Harris hip score (HHS) score of 38.8
Summary
Since tissue sparing surgery (TSS) hip replacement was introduced, it has been greeted both with enthusiasm and concern. We have chosen the first 20 cases as the learning curve based on articles by Woolson et al [2] and Archibeck and White [3], which demonstrate a high rate of complications in minimally invasive total hip arthroplasty (THA) during a surgeon’s early experience with these methods. Both surgeons and patients should be reminded to focus on the potential benefits and on the risks of new techniques. Conclusion The antero-lateral TSS approach seems to be safer and less demanding than standard THR surgery, and is suitable for use with different stems
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