Incision Total Hip Arthroplasty Research Articles

Effect of fascia iliaca compartment block on anterolateral small incision total hip arthroplasty

To compare the effects of simple intraspinal anesthesia and combined fascia iliaca compartment block(FICB) on total hip arthroplasty(THA) through anterior lateral small incision (orthop dische chirurgie München, OCM). From January 2019 to October 2020, patients undergoing unilateral total hip arthroplasty were treated with intraspinal anesthesia combined with ultrasound-guided fascia iliaca compartment block(30 cases in group A) and simple intraspinal anesthesia(30 cases in group B). Two groups were treated with the same intravenous analgesia after operation. The operation time, the amount of bleeding, the peeling degree of middle gluteal muscle, the splitting of greater trochanter of femur, the visual analysis scale (VAS) of hip joint after operation, the abductor muscle strength of quadriceps femoris and hip joint before and 48 hours after operation, and the Harris score of hip joint function after operation were observed and compared between two groups. All patients were followed up for 48 to 62 weeks with an average of (54.2±4.0) weeks. The incision length, operation time and intraoperative bleeding in group A were significantly lower than those in group B (P<0.05). The level of hemoglobin 24 hours after operation in group A was significantly higher than that in group B (P<0.05). The abductor muscle strength of hip joint in group A was significantly higher than that in group B 48 hours after operation (P<0.05). The degree of middle gluteal muscle dissection in group A was significantly lower than that in group B (P<0.05). The VAS of group A at 8, 12 and 24 hours after operation was significantly lower than that of group B (P<0.05);The Harris score in group A was significantly higher than that in group B at 2 and 8 weeks after operation (P<0.05). The application of ultrasound-guided fascia iliaca compartment block in lateral position OCM approach THA can significantly shorten the operation time, reduce the amount of bleeding, reduce the perihip trauma such as the peeling of middle gluteal muscle during operation, and improve the early postoperative pain of patients, which is conducive to the clinical operation of OCM approach and the rapid postoperative recovery of patients.

Minimal Incision Total Hip Arthroplasty: A Concise Follow-up Report on Functional and Radiographic Outcomes at 10 Years.

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Randomized Clinical Trial of 2-Incision vs Mini-Posterior Total Hip Arthroplasty: Differences Persist at 10 Years

BackgroundA previous randomized clinical trial at our institution demonstrated slower recovery of 35 2-incision total hip arthroplasties (THAs) when compared with 36 mini-posterior THAs at 2 years. The primary aim of the present study was to report concise 10-year follow-up results. MethodsWe retrospectively reviewed the 71 patients in the previous randomized clinical trial, comparing clinical outcomes, revisions, reoperations, and implant survivorship between the 2-incision and the mini-posterior THAs. ResultsAt the most recent follow-up, the mean Harris hip score was 85 in the 2-incision group and 87 in the mini-posterior group (P = .4). There were 4 revisions and 2 reoperations (16%) in the 2-incision group vs 1 revision and 3 reoperations (11%) in the mini-posterior group (P = .5). Ten-year survivorship free of aseptic revision or reoperation was 77% in the 2-incision group vs 90% in the mini-posterior group (P = .15). ConclusionThere were no improvements in early or midterm clinical outcomes with the 2-incision technique. However, there was a clinical trend toward a higher rate of aseptic revisions in the 2-incision THA group.

A Prospective Randomized Trial of Mini-Incision Posterior and 2-Incision Total Hip Arthroplasty: Minimum 5-Year Follow-Up

BackgroundWe previously described the results of a randomized controlled trial of mini-posterior vs 2-incision total hip arthroplasty and were unable to demonstrate significant differences in early outcomes. As less-invasive anterior approaches remain popular, the purpose of this report was to re-examine the outcomes at a minimum 5-year follow-up. MethodsSeventy-two patients undergoing primary total hip arthroplasty were randomized to a mini-posterior or 2-incision approach. Complications, revisions, and clinical outcome measures were compared. Radiographs were reviewed for implant loosening. A power analysis using a minimal clinically important difference value of 6 points for the Harris hip score revealed 28 patients required per group. ResultsAt a mean of 8.2 years (range, 5-10 years), 6 patients died without revision surgery and 63 of 66 living patients were reviewed. There were 6 total failures, 3 in each group. For unrevised patients, there were no significant differences between groups (posterior vs 2-incision) in the Harris hip score (95.5 ± 3.5 vs 95.7 ± 6.3; P = .88), 12-item Short Form Survey physical composite score (50.5 ± 8.5 vs 49.0 ± 9.1; P = .53), 12-item Short Form Survey mental composite score (57.3 ± 4.1 vs 55.4 ± 8.0; P = .25), or single assessment numeric evaluation score (97.1 ± 3.7 vs 97.8 ± 5.2; P = .55). ConclusionWe found no differences in midterm outcomes between the 2 approaches. Given the increased complexity, operative time, and need for fluoroscopy with the 2-incision approach combined with equivalent early and midterm outcomes, the 2-incision approach has been abandoned in the senior author's practice.

Experience in posterolateral mini-incision total hip arthroplasty

To explore the surgical techniques in posterolateral mini-incision total hip arthroplasty and clinical efficacy. A total of 94 patients (98 hips) had posterolateral mini-incision total hip arthroplasty, from December 2006 to December 2008, and were randomly divided into a posterolateral miniincision total hip arthroplasty group (Group A) and a conventional group of posterolateral incision for total hip arthroplasty (Group B). Forty-nine patients (50 hips) in Group A had posterolateral small incision total hip arthroplasty [26 males, 23 females, between 37.0 and 95.0 years (average 68.9 years), body mass index (BMI) between 20.3 and 29.7 (average BMI 25.4)]. Forty-five patients (48 hips) in Group B had the conventional posterolateral incision [27 males, 18 females, between 45.0 and 92.0 years (average 69.7 years), BMI between 18.7 and 34.1 (average BMI 26.9)]. The incision length, blood loss, drainage, operation time, and postoperative Harris scores were compared between the 2 groups. The incision length was 6.0~10.5 (average length 7.4) cm, average blood loss was 387.6 (140.0~1000.0) mL, average drainage was 143.1 (63.0~375.0) mL, average blood transfusion was 77.6 (0~400.0) mL, average operation time was 84.6 (63.0~130.0) min, and vitalock abduction angle imaging after the operation was 41.6° (averagely 38.0°~57.0°) in Group A. The incision length was 15.0~23.0 (average length 20.0) cm, average blood loss was 513.1 (210.0~1350.0) mL, average drainage was 152.3 (70.0~520.0) mL, average blood transfusion was 142.2 (0~800.0) mL, average operation time was 84.0 (71.0~115.0) min, and postoperative radiographic acetabular cup abduction angle was 42.3° (37.0°~54.0°) in Group B. The follow-up showed that the prosthesis of the 2 groups was in a good position, Harris score was significantly improved with no complications after total hip arthroplasty in the 2 groups. With the correct selection of indications and adept operation skills and other circumstances, posterolateral mini-incision total hip arthroplasty may do little damage to the soft tissue with a small scar on the skin. The imaging evaluation after the operation and the Harris score show no difference between the 2 groups. Patients are satisfied with their joint function and postoperative recovery.

Mini-Incision versus Standard Incision Total Hip Arthroplasty Regarding Surgical Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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.

Comparison of Complications in Single-incision Minimally Invasive THA and Conventional THA

The purpose of this meta-analysis was to investigate whether single-incision minimally invasive total hip arthroplasty (THA) is superior to conventional incision THA by comparing postoperative complication rates, Harris Hip Scores, and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores. Randomized, controlled trials comparing single-incision minimally invasive THA and conventional THA were reviewed. The methodological quality of each randomized, controlled trial was assessed using the Physiotherapy Evidence Database (PEDro) scale (Centre for Evidence-based Physiotherapy, The George Institute for Global Health, New South Wales, Australia). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to determine the quality of the evidence. Fourteen studies involving 1254 patients (1329 hips) were included in the meta-analysis, comprising 659 single-incision minimally invasive THAs (mean patient age, 63.9 years) and 670 conventional incision THAs (mean patient age, 65.0 years). A funnel plot of postoperative complication rates showed that a slight publication bias existed in the study. According to the meta-analysis, no significant statistical difference was observed in complication rates in no more than 3 postoperative years (odds ratio=1.06; 95% confidence interval, 0.69 to 1.63; P=.79), in Harris Hip Scores in no more than 2 postoperative years (weighted mean difference=0.71; 95% confidence interval, -3.09 to 4.51; P=.71), and in WOMAC scores at 6 weeks postoperatively (weighted mean difference=-0.55; 95% confidence interval, -3.54 to 2.44; P=.72) between single-incision minimally invasive THA and conventional THA. Therefore, single-incision minimally invasive THA is not superior to conventional THA in early postoperative recovery, hip function, and complication rate.

Two-Incision Minimally Invasive vs Standard Total Hip Arthroplasty: Comparison of Component Position and Hospital Costs

Forty-nine patients undergoing 2-incision total hip arthroplasty were matched by age, gender, body mass index, and comorbidity to patients undergoing a standard lateral Hardinge approach. Hospital costs and charges were compared along with length of stay, component position, and complication rates. Component position and complication rates were identical for the 2 groups. However, hospital costs and charges were significantly lower for the 2-incision group, as was length of stay.

Minimal Incision Surgery as a Risk Factor for Early Failure of Total Hip Arthroplasty

Minimal incision total hip arthroplasty (MI THA) techniques were developed to decrease postoperative pain and recovery time. Although these techniques have increased in popularity, the long-term survivorship of these procedures is unknown. We therefore investigated whether the time to revision in our referral practice was shorter for patients who underwent primary MI THA compared to primary traditional THA. We retrospectively reviewed 46 revision THAs performed during a 3-year period. We excluded revisions performed for infection and rerevisions. Patients with incisions less than or equal to 10 cm were defined as having had MI THA. Fifteen of the 46 patients (33%) had undergone primary MI THA. At the time of primary index THA, the mean ages of the MI and non-MI patients were 65 years and 55 years, respectively. The mean time to revision was 1.4 years for the MI patients compared with 14.7 years for the non-MI patients. Twelve of the 15 patients having MI THA required revision within 2 years of primary THA compared to 4 of the 31 patients without MI surgery (OR = 26.5, 95% CI 4.4-160.0). There were no differences between the groups with regard to age, gender, or body mass index. The most common reasons for revision in the MI THA group were intraoperative fracture and failure of femoral component osseointegration. Our data suggest MI THA may be a risk factor for early revision surgery and the long-term survival therefore may be lower than that for non-MI surgery. Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Heterotopic Ossification After 2-Incision Total Hip Arthroplasty

We examined the incidence of heterotopic ossification (HO) in a consecutive series of total hip arthroplasties (THAs) performed with the so-called minimally invasive, 2-incision technique. Standard preoperative hip radiographs were used to grade the extent of degenerative arthritis, and comparable follow-up radiographs at 30 months after surgery were used to detect and classify HO formation. Of 121 patients, 32 (26.5%) developed HO, with the Brooker class distribution as follows: stage I, 16 patients; stage II, 9 patients; stage III, 6 patients; stage IV, 1 patient. In this study, HO formation after 2-incision THA occurred with nearly the same frequency as that reported in other studies after standard THA.

One Surgeon's Experience With the 2-Incision Technique for Total Hip Arthroplasty

This study's purpose was to analyze the complications that occurred during and after one surgeon's first 200 two-incision total hip arthroplasties. Complications included 4 intraoperative femur fractures, 4 postoperative femur fractures, 2 nondisplaced greater trochanter fractures greater than 2 cm, 14 asymptomatic greater trochanter fractures 2 cm or less, 1 malpositioned cup requiring revision, 1 loose stem, 7 cases of heterotopic ossification of grade 2 or higher, 4 dislocations, 1 superficial infection, 80 lateral femoral cutaneous nerve neuropraxias (78 resolved within 6 weeks), and 4 femoral nerve neuropraxias (3 resolved within 12 weeks). This study shows that the 2-incision technique can be performed with a low risk of major complications, and patients can expect reduced tissue trauma and faster rehabilitation. When carefully sought out, minor complications were not uncommon after 2-incision total hip arthroplasty.

Fluoroscopy Cannot Recognize Intraoperative Fracture in Patients Receiving 2-Incision Total Hip Arthroplasty

Intraoperative fluoroscopy is suggested as a standard procedure in 2-incision total hip arthroplasty. Between September 2003 and July 2004, 2-incision total hip arthroplasties were done in 18 hips with and another 18 hips without the use of fluoroscopy. In group 1, the anterior skin incision was initially limited to 5 cm. Fracture or instability was checked by fluoroscopy first and then the incision was enlarged to 8 cm for visualization. In group 2, incisions were made long enough to expose the surgical field. There were 2 femoral neck fractures in the fluoroscopy group. The fractures were linear in the anteromedial femoral neck and could not be detected by fluoroscopy. Such linear fractures if overlooked could result in serious complications such as fracture displacement or implant instability. Surgeons should not rely on intraoperative fluoroscopy to check implant stability, and visualization of the surgical field should not be compromised when doing minimally invasive approach for total hip arthroplasty.

Component Position in 2-Incision Minimally Invasive Total Hip Arthroplasty Compared to Standard Total Hip Arthroplasty

Minimally invasive surgery (MIS) for total hip arthroplasty (THA) has sparked controversy in the orthopedic community, including debate regarding the reliability and reproducibility of component placement. We reviewed a single surgeon's 1-year experience by comparing postoperative radiographs of 67 MIS 2-incision THA and 28 standard THA for acetabular inclination, acetabular version, and femoral stem angulation. Acetabular inclination/version averaged 42.2°/16.5° and 38.7°/15.5° for MIS and THA, respectively. Femoral angulation averaged 0.007° varus and 0.411° varus for MIS and standard THA approaches, respectively. Radiographic assessment of component position of THA in 2-incision MIS vs a standard direct lateral approach reveals no significant differences. Components are placed in acceptable positions with both techniques.

The Two Incision Total Hip Arthroplasty: Technique and Results

The two-incision technique for total hip arthroplasty (THA) has evolved rapidly over the past decade with the aid of training courses, new instrumentation, and cadaver laboratories. We describe our technique, choice of implants, and outcomes using this method. While there is clear evidence of a learning curve for two-incision THA, the number of complications and operative times both declined after the 20th case in our series. We conclude that, with appropriate training, both in the laboratory and with surgeon experience, two-incision THA can be a safe alternative to more invasive hip replacement surgery.

Early Outcomes of Total Hip Replacements with the Minimally Invasive Two-Incision Technique

A consecutive series of 65 patients undergoing Minimally Invasive Solutions (MIS) II Incision total hip arthroplasty (THA) performed by a single surgeon is retrospectively reviewed. The initial group of patients beginning with the surgeon’s first procedure and those followed with a minimum of 1-year follow-up were included in the study. At 2 years postop, 30 patients had information tabulated for Harris Hip Scores, with an average score of 88. Radiographic evaluation showed no signs of loosening, implant subsidence, radiolucent lines, or change in component alignment. In the author’s experience, the MIS II incision THA is a safe and extremely beneficial arthroplasty technique for many patients.

A Prospective Randomized Clinical Trial Shows That 2-Incision Total Hips Do Not Recover Quicker Than Miniposterior Total Hips

Proponents of 2-incision total hip arthroplasty (THA) have claimed that the recovery after that procedure is dramatically quicker than that after other methods of performing THA. To date however, there are no data that directly compare 2-incision THA to another method of THA in similar groups of patients using the same advanced anesthetic and rehabilitation protocol.

Effect of cup orientation in minimal incision total hip arthroplasty with CT-based navigation system

Effect of cup orientation in minimal incision total hip arthroplasty with CT-based navigation system

Comparison of the 2-Incision and Mini-Incision Posterior Total Hip Arthroplasty Technique: A Retrospective Match-Pair Controlled Study

We compared the outcomes of the mini-posterior and 2-incision total hip arthroplasty approaches by analyzing 43 matched pairs of patients. The following outcomes were evaluated: (1) Harris Hip Score, (2) Medical Outcomes Study 36-Item Short-Form Health Survey, (3) the Medical Outcomes Study Sleep Scale, and (4) the Western Ontario and McMaster Osteoarthritis Index. Function was regained earlier by patients having the 2-incision total hip arthroplasty as determined by length of hospitalization ( P = .002) and multiple return to function parameters, although this may be the result of hip precautions placed on the posterior group. Posterior mini-incision patients had less operating time ( P < .0001) and blood loss ( P = .001). Complications did not differ between surgical techniques. No patients were revised. The 2-incision operation was better for function and length of stay, and the posterior mini-incision was easier to perform, although these groups used different selection criteria.

Severe Symptomatic Heterotopic Ossification and Dislocation: A Complication After Two-Incision Minimally Invasive Total Hip Arthroplasty

Minimally invasive total hip arthroplasty (THA) continues to be surrounded by controversy. Some proponents argue that they are able to achieve reduced soft tissue trauma, blood loss, postoperative pain, and hospitalization time as well as a more cosmetically pleasing surgical scar. Types of complications similar to those of a more open exposure are now being reported with these techniques. One such complication is the development of severe symptomatic heterotopic ossification requiring treatment. This case report profiles a patient who required removal of Brooker stage III heterotopic ossification after a 2-incision minimally invasive total hip THA. This is the first report of this complication after 2-incision THA.

Mini-incision Total Hip Arthroplasty: The Posterior Approach

To improve patients' outcomes and shorten the hospital stay, surgeons throughout the world have explored the option of mini-invasive total hip arthroplasty. Exciting initial reports caught media attention, and today most patients expect mini-incision total hip replacement to reduce complication rate, accelerate rehabilitation, and provide a more attractive appearance. However, recent reports have highlighted that a shorter incision can increase the risk of perioperative complication. At the same time, studies show no difference in early rehabilitation and hospital stay between patients undergoing mini-incision and standard incision total hip arthroplasty. Although there is no question that recent advances in mini-incision total hip arthroplasty have led to significant improvements in perioperative care (preoperative patient education, anesthesia management, and postoperative rehabilitation protocols) a shorter incision might offer few clinical benefits besides a more attractive scar. The current article describes the technique of posterolateral mini-incision total hip arthroplasty and provides a review of the current literature.