Minimally invasive and computer-navigated total hip arthroplasty: a qualitative and systematic review of the literature

Inge Hf Reininga,Wiebren Zijlstra,Sjoerd K Bulstra,Alexander L Boerboom,Robert Wagenmakers,Johan W Groothoff,Martin Stevens,Bregtje P Huijbers

doi:10.1186/1471-2474-11-92

Abstract

BackgroundBoth minimally invasive surgery (MIS) and computer-assisted surgery (CAS) for total hip arthroplasty (THA) have gained popularity in recent years. We conducted a qualitative and systematic review to assess the effectiveness of MIS, CAS and computer-assisted MIS for THA.MethodsAn extensive computerised literature search of PubMed, Medline, Embase and OVIDSP was conducted. Both randomised clinical trials and controlled clinical trials on the effectiveness of MIS, CAS and computer-assisted MIS for THA were included. Methodological quality was independently assessed by two reviewers. Effect estimates were calculated and a best-evidence synthesis was performed.ResultsFour high-quality and 14 medium-quality studies with MIS THA as study contrast, and three high-quality and four medium-quality studies with CAS THA as study contrast were included. No studies with computer-assisted MIS for THA as study contrast were identified. Strong evidence was found for a decrease in operative time and intraoperative blood loss for MIS THA, with no difference in complication rates and risk for acetabular outliers. Strong evidence exists that there is no difference in physical functioning, measured either by questionnaires or by gait analysis. Moderate evidence was found for a shorter length of hospital stay after MIS THA. Conflicting evidence was found for a positive effect of MIS THA on pain in the early postoperative period, but that effect diminished after three months postoperatively. Strong evidence was found for an increase in operative time for CAS THA, and limited evidence was found for a decrease in intraoperative blood loss. Furthermore, strong evidence was found for no difference in complication rates, as well as for a significantly lower risk for acetabular outliers.ConclusionsThe results indicate that MIS THA is a safe surgical procedure, without increases in operative time, blood loss, operative complication rates and component malposition rates. However, the beneficial effect of MIS THA on functional recovery has to be proven. The results also indicate that CAS THA, though resulting in an increase in operative time, may have a positive effect on operative blood loss and operative complication rates. More importantly, the use of CAS results in better positioning of acetabular component of the prosthesis.

Highlights

Both minimally invasive surgery (MIS) and computer-assisted surgery (CAS) for total hip arthroplasty (THA) have gained popularity in recent years
The results of the comparison of the Description Was the method of randomization adequate? Was the treatment allocation concealed? Were the groups similar at baseline regarding the most important prognostic indicators? Was the outcome assessor blinded to the intervention? Were co-interventions avoided or similar? Was the drop-out rate described and acceptable? Was the timing of the outcome assessment similar in all groups? Did the analysis include an intention-to-treat analysis?
Strong evidence was found for an increase in operative time and for no significant difference in complication rates after CAS THA

Summary

Introduction

Both minimally invasive surgery (MIS) and computer-assisted surgery (CAS) for total hip arthroplasty (THA) have gained popularity in recent years. Total hip arthroplasty (THA) is considered to be one of the most successful orthopaedic interventions of the past 40 years, with 10-year survival rates exceeding 90% [1,2]. The concept of Despite the increase in use of MIS THA, its risks and benefits are still an ongoing debate issue in the orthopaedic society. Opponents claim that MIS THA introduces additional risks due to limited visibility of anatomical landmarks and vital structures [6]. Complications involve higher risks for thromboembolism, infection, neurovascular injury, femoral fracture and component malposition, which can result in increased prosthetic wear [7,8]

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