Invasive Two-incision Total Hip Arthroplasty Research Articles

Comparison of Minimally Invasive Total Hip Arthroplasty versus Conventional Hemiarthroplasty for Displaced Femoral Neck Fractures in Active Elderly Patients.

Fractures of the femoral neck in elderly patients can be treated by internal fixation, hemiarthroplasty, or total hip arthroplasty (THA), and the treatment modality used should be determined on the basis of considerations of the degree of fracture displacement, age, functional demands, and the risk factors for surgery and anesthesia. We studied 85 active elderly patients who underwent minimally invasive two-incision THA or conventional bipolar hemiarthroplasty (BHA) within 2 weeks of injury for the treatment of acute displaced femoral neck fractures. Patients were followed up for a minimum of 24 months. The average operation times were 70 minutes in the THA group and 46 minutes in the BHA group (p=0.002), and average blood losses during the perioperative period were 921 cc and 892 cc, respectively (p=0.562). In the THA group, the average postoperative Harris hip score was 88.3 and the average Western Ontario and McMaster University score was 28.8, whereas in the BHA group the corresponding scores were 80.4 (p=0.006) and 32.5 (p=0.012), respectively. There were 2 cases of hip dislocation in the THA group, and 2 cases in the BHA group underwent conversion to THA. Our short-term follow-up results were better for minimally invasive two-incision THA than for conventional BHA for the treatment of acute displaced femoral neck fractures in active elderly patients.

Modified minimally invasive two-incision total hip arthroplasty using large diameter femoral head

Background:Minimally invasive (MI) total hip arthroplasty (THA) is an alternative to standard THA, but has created much controversy among orthopedic surgeons. The authors modified the original minimally invasive two-incision THA technique and used large-diameter (32 mm, 36 mm) ceramic-on-ceramic articulation.Materials and Methods:One hundred and seventy patients that underwent unilateral MI two-incision THA were retrospectively reviewed, and surgical morbidity, functional recovery, radiological properties, and complications were assessed.Results:Mean Harris hip score (HHS) improved from 41.8 to 96.1 at last followup, and mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score from 66.2 to 26.9. The mean lateral opening angle of the acetabular component was 38.2° and the mean stem position was valgus 1.9°. There was an intraoperative femur fracture and one revision surgery due to stem subsidence. No patient had dislocation.Conclusions:Our data suggest that this modified technique combined with large ceramic femoral head is safe and reproducible in terms of achieving proper implant positioning and early functional recovery.

Bilateral simultaneous two-incision minimally invasive total hip arthroplasty

BackgroundThis study aimed to assess the feasibility of bilateral simultaneous minimally invasive two-incision total hip arthroplasty in terms of clinical and radiological outcomes, complications, and patient satisfaction. MethodsA total of 62 patients, ages 24-69 years, were operated on with bilateral simultaneous minimally invasive total hip arthroplasty using a modified two-incision technique, after which they were followed for an average 41 months. The acetabular component was inserted through part of the Watson-Jones approach, and a femoral component was inserted through a space between the gluteus medius and piriformis tendon. ResultsThe mean duration of surgery was 180.4 min, and the mean perioperative blood loss was 1513.2 ml. There were no intraoperative complications. Postoperative periprosthetic fracture occurred in two patients and delayed infection in one patient. The average Harris Hip Score improved from 41.8 to 95.3. The WOMAC score improved from an average of 66.2 to 5.0. The average lateral opening angle of the acetabulum was 40°, and the angle of anteversion was 12°. All the femoral components were implanted in neutral to 5° valgus position. ConclusionsBilateral simultaneous minimally invasive total hip arthroplasty using a modified two-incision technique gave satisfactory clinical, radiological, and functional results. Efforts should be made to prevent perioperative peripros-thetic fractures.

Minimally Invasive Two-Incision Total Hip Arthroplasty: Is the Second Incision Necessary?

This article refutes the need for the posterior incision in minimally invasive two-incision total hip replacement. A description of how the Smith-Petersen, direct anterior, approach can be used to expose and implant the femoral components is given. Data from a prospective comparison of direct anterior and modified Hardinge approaches is presented. Seventy-nine patients in matched groups were analyzed. There was no difference between the groups in average body mass index, surgical time, incision length, hospital stay, pain, blood loss, or complications. At the six-month follow up evaluation slightly better outcomes were seen for the direct anterior approach when compared to the direct lateral approach. Limiting exposure to the anterior incision eliminates soft tissue and muscular damage. Other concerns such as intraoperative fractures, stem malpositioning, and prolonged surgeries are not seen with the direct anterior technique. Minimally invasive total hip arthroplasty can be performed safely with excellent results using the direct anterior incision alone.

Anterior Approach Total Hip Arthroplasty: The Heuter Interval

The authors report on outcomes from a consecutive series of 450 total hip arthroplasty patients who underwent surgery with a single-incision anterior approach to the hip joint. This approach is relevant to minimally invasive two-incision total hip arthroplasty, since the anterior portion of the two-incision technique is identical to that described here. Complications with the single incision technique, including thigh sensory changes and periprosthetic femur fractures, are reported, and the authors discuss how these may be avoided. In the authors' experience with total hip arthroplasty through the anterior approach, patients report reduced postoperative pain and experience more rapid recovery, with less surgical scarring.

Minimally Invasive Two-Incision Total Hip Arthroplasty for Treating Acute Displaced Femoral Neck Fractures in Active Elderly Patients

Purpose: The purpose of this study was to evaluate the short term follow-up results of minimally invasive (MI) two-incision total hip arthroplasty (THA) for treating acute displaced femoral neck fractures in active elderly patients. Materials and Methods: We performed a retrospective review of 39 cases (average age: 72 years old, range: 60 years and above) of elderly patients who underwent MI two-incision THA within 30 days of their injury for treating displaced acute femoral neck fracture s. They were followed up for a minimum of 12 months. Clinical evaluation was done by comparing the pre-injury and postoperative daily activities, the Harris Hip score (HSS) and the Western Ontario and McMaster University (WOMAC) score. The radiographs were checked to evaluate for implant alignment and periprosthetic abnormalities. The postoperative complications were analyzed. Results: The average postoperative HSS was 88.3 and the average WOMAC s core was 28.8. All the patients were able to walk without any assistive device. One patient had a HHS of less than 70. There were 2 dislocations but there was no recurrence. Radiographically, there was no case with a limb length discrepancy of more than 5mm. The femoral stems did not reveal any subsidence of more than 5mm. Other complications such as osteolysis, infection, neurologic injury and intraoperative periprosthetic fracture were not noted. Especially, no patient complained of any groin pain, which often occurs after bipolar hemiarthroplasty. Conclusion: The short term follow-up results were good for MI two-incision THA to treat acute displaced femoral neck fractures in active elderly patients, and these procedures were done by an experienced hip surgeon.

Early Results of Minimally Invasive Two-Incision Total Hip Arthroplasty: A Review at 24-Month Follow-Up

With a growing interest from patients in minimally invasive total hip replacements, more follow-up reports on two-incision minimally invasive total hip arthroplasty (MI-THA) are needed to help define risks, patient criteria, and adequate training measures. This study reports early results of 125 two-incision MI-THAs (minimum 2 years). The average age of the patients was 62.4 years, their average body mass was 27, all had Dorr B or better bone, and none had previous hardware. Average hospital was stay was 1.2 days. There were two (1.6%) major complications: one femoral nerve neuropraxia and one periprosthetic fracture occurred when a patient fell 4 weeks after the primary THA, necessitating reoperation. There were 15 (12%) total complications, excluding 38 (30.4%) cases with lateral femoral nerve parathesias, of which all were resolved or of little consequence at 24 months. The authors believe this minor complication is an element of the surgery and that prospective patients be advised of it. Results suggest that two-incision MI-THA may permit earlier function than standard THAs and can be performed with an acceptable complication rate when done on select clients by specially trained hip specialists.

Minimally invasive two-incision total hip arthroplasty: a short-term retrospective report of 27 cases

Total hip arthroplasty (THA) is widely applied for the treatment of end-stage painful hip arthrosis. Traditional THA needed a long incision and caused significant soft tissue trauma. Patients usually required long recovery time after the operation. In this research we aimed to study the feasibility and clinical outcomes of minimally invasive two-incision THA. From February 2004 to March 2005, 27 patients, 12 males and 15 females with a mean age of 71 years (55 - 76), underwent minimally invasive two-incision THA in our department. The patients included 9 cases of osteoarthritis, 10 cases of osteonecrosis, and 8 cases of femoral neck fracture. The operations were done with VerSys cementless prosthesis and minimally invasive instruments from Zimmer China. Operation time, blood loss, length of incision, postoperative hospital stay, and complications were observed. The mean operation time was 90 minutes (80 - 170 min). The mean blood loss was 260 ml (170 - 450 ml) and blood transfusion was carried out in 4 cases of femoral neck fracture (average 400 ml). The average length of the anterior incision was 5.0 cm (4.6 - 6.5 cm) and of the posterior incision 3.7 cm (3.0 - 4.2 cm). All of the patients were ambulant the day after surgery. Nineteen patients were discharged 5 days post-operatively and 8 patients 7 days post-operatively. The patients were followed for 18 months (13 - 25 months). One patient was complicated by a proximal femoral fracture intraoperatively. No other complications, including infections, dislocations, and vascular injuries, occurred. The mean Harris score was 94.5 (92 - 96). Two-incision THA has the advantage of being muscle sparing and minimally invasive with less blood loss and rapid recovery. However, this technique is time consuming, technically demanding, and requires fluoroscopy.

Patients Preferred a Mini-posterior THA to a Contralateral Two-incision THA

The two-incision total hip arthroplasty (THA) technique has been touted as offering substantially faster recovery than other methods of THA, but direct comparison studies in similar groups of patients have not been done. We sought to determine if there was a difference in the early functional outcome after a two-incision THA compared to a mini-posterior THA as measured by the time to reach defined milestones of daily activity. We also evaluated which procedure the patients preferred. Twenty-six patients underwent staged bilateral total hip arthroplasties with a two-incision minimally invasive THA on one hip and a mini-posterior THA on the contralateral hip. The same comprehensive anesthesia and rapid rehabilitation protocol was used after each operation. Patients were reviewed retrospectively a minimum of 6 months after the second total hip arthroplasty. There were no differences in the time to discontinue ambulatory aids, return to driving, climb stairs, return to work, or walk 1/2 mile. Sixteen of 26 patients preferred the mini-posterior total hip arthroplasty and two patients had no preference. The added surgical technical difficulty of the two-incision minimally invasive total hip arthroplasty was not rewarded with an earlier return to functional activities and more patients preferred their mini-posterior total hip arthroplasty.

Minimally invasive total hip arthroplasty: the two-incision approach

Purpose of review: The minimally invasive two-incision total hip arthroplasty is a surgical technique that offers patients an intramuscular interval that facilitates postoperative recovery and rehabilitation time. The vast majority of patients are discharged from the hospital within 24 hours. The minimally invasive two-incision total arthroplasty technique offers certain patients an excellent alternative to traditional total hip arthroplasty. Recent findings: Although recent literature on this topic is confined to preliminary results in terms of long-term outcomes found in the total arthroplasty literature, the short-term results and benefits of early rehabilitation and hospital discharge are promising. Smaller incisions, shorter rehabilitation times, early hospital discharge, quicker return to activities of daily living, and development of improved total hip arthroplasty critical pathways in a more compressed time frame have emerged in recent articles. Summary: Development of the two-incision total hip arthroplasty technique is a safe and viable alternative in selective patients as an alternative to conventional total hip arthroplasty. The two-incision technique relies on a muscle-sparing interval, which promotes a shorter recovery time. This technique is a promising alternative to traditional total hip arthroplasty because of the shorter incision, intramuscular interval, quicker recovery time, and earlier return to activities of daily living based on preliminary studies from multiple centers.