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Abstract
PurposeIt remains controversial whether mini-incision (MI) benefits patients in total hip arthroplasty (THA). We performed a meta-analysis of randomized controlled trials (RCTs) to assess the effects of MI on surgical and functional outcomes in THA patients.MethodsA systematic electronic literature search (up to May 2013) was conducted to identify RCTs comparing MI with standard incision (SI) THA. The primary outcome measures were surgical and functional outcomes. According to the surgical approach taken, MI THA patients were divided into four subgroups for sub-group meta-analysis. Standardized mean differences (SMDs) or risk differences (RDs) with accompanying 95% confidence intervals (CIs) were calculated and pooled using a fixed-effect or random-effect model according to the heterogeneity.ResultsA total of 14 RCTs involving THA 1,174 patients met the inclusion criteria. The trials were medium risk of bias. The overall meta-analysis showed MI THA reduced total blood loss (95% CI, -201.83 to -21.18; p=.02) and length of hospital stay ( 95% CI, -0.67 to -0.08; p=.01) with significant heterogeneity. However, subgroup meta-analysis revealed posterior MI THA had perioperative advantages of reduced surgical duration ( 95% CI, -8.45 to -2.67; P<.001), less blood loss ( 95% CI, -107.20 to -1.73; P=.04) and shorter hospital stay ( 95% CI, -0.74 to -0.06; p=.002) with low heterogeneity. There were no significant differences between MI and SI THA groups in term of pain medication dose, functional outcome (HHS), radiological outcome or complications (P>.05, respectively).ConclusionsAlthough no definite overall conclusion can be arrived at on whether MI THA is superior to SI THA, posterior MI THA clearly result in a significant decrease in surgical duration, blood loss and hospital stay. It seems to be a safe minimally invasive surgical procedure without increasing the risk of component malposition or complications.
Highlights
The consequences of introducing mini-incision (MI) into total hip arthroplasty (THA) are still a debating topic in all orthopedic forums [1]
As for hip functional score, our results demonstrated that MI THA resulted in similar Harris Hip Score (HHS) compared with standard incision (SI) THA, consistent with some studies [6,8,9] but contrary to other reports [7,11]
Our meta-analysis found no significant difference in nerve injury between MI and SI THA, in agreement with one previous study [13] but in disagreement with a systematic review and meta-analysis [9] that showed an association of MI THA with a significantly increased risk of transient lateral femoral cutaneous nerve palsy
Summary
The consequences of introducing mini-incision (MI) into total hip arthroplasty (THA) are still a debating topic in all orthopedic forums [1]. Some have shown that MI THA is more prone to complications, mainly due to component malpositioning with an increased risk of dislocation, in addition to an increased risk of neurovascular complications and excessive skin trauma [5]. Another drawback seems to be the learning curve which tends to be longer for surgeons with little experience of hip prosthetic surgery
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