Mini-incision Total Hip Arthroplasty Research Articles

Is the Anterolateral or Posterolateral Approach More Effective for Early Postoperative Recovery after Minimally Invasive Total Hip Arthroplasty?

Currently, various minimally invasive surgical techniques are applied for total hip arthroplasty (THA). There are few studies comparing the early postoperative clinical outcomes of minimally invasive THA between anterolateral and posterolateral approaches. In this retrospective study, 62 patients underwent minimally invasive THA via either the anterolateral approach with an intermuscular exposure using the modified Watson-Jones approach (MIS-AL, 34 hips) or mini-incision THA with a posterolateral approach (MIS-PL, 28 hips). We analyzed intraoperative data, postoperative hematological data, postoperative radiographic findings, and the postoperative recovery of muscle strength. The mean surgical time was significantly longer in the MIS-PL than in the MIS-AL group. The mean postoperative serum C-reactive protein level was significantly higher in the MIS-PL group than in the MIS-AL group only on postoperative day 3. There were no significant between-group differences in the postoperative recovery rate of muscle strength during hip abduction. The recovery rate of muscle strength during hip extension was better in the MIS-AL group than in the MIS-PL group only on postoperative day 3. In conclusion, we found no obvious advantage in early postoperative recovery between the MIS-AL and MIS-PL approaches. Therefore, the benefit of rapid postoperative recovery was comparable between the MIS-AL and MIS-PL approaches.

Supercapsular percutaneously-assisted total hip (SuperPath) versus mini-incision posterolateral total hip arthroplasty for hip osteoarthritis: a prospective randomized controlled trial.

BackgroundSupercapsular percutaneously-assisted total hip (SuperPath) arthroplasty has been proposed to be minimally invasive and tissue sparing, with possible superior postoperative outcomes compared with conventional approaches for total hip arthroplasty (THA). However, previous studies have underlined the shortcomings of conventional THA approaches, including higher dislocation, more blood loss, longer incisions, more tissue damage, and delayed postoperative rehabilitation. In the present study, we compared the short-term outcomes of unilateral THA with those of SuperPath and the mini-incision posterolateral approach (PLA) for hip osteoarthritis (OA).MethodsPatients with unilateral hip OA were prospectively recruited and underwent either SuperPath (SuperPath group) or mini-incision PLA THA (PLA group). Perioperative status [operative time, incision length, intraoperative blood loss, soft tissue damage, and length of hospital stay (LOS)], and postoperative function outcomes, including range of motion (ROM), pain visual analog scale (VAS), and Harris Hip Score (HHS), were evaluated and compared between the groups at scheduled time points within 12 months postoperatively.ResultsCompared with the PLA group, the SuperPath group yielded a significantly shorter incision length (7.83 vs. 12.45 cm, P<0.001), longer operative time (102.72 vs. 66.22 min, P<0.001), more blood loss (1,007.38 vs. 844.55 mL, P=0.005), and more soft tissue damage (creatine kinase: 1,056.05 vs. 821.50 U/L, P=0.006) on postoperative day 3. The SuperPath group also showed deficient acetabular cup positioning (abduction angle: 36.94° vs. 42.66°, P=0.004) and a greater decrease in ROM (flexion: 107.66° vs. 114.44°, P=0.004; 109.83° vs. 116.11°, P=0.002; 111.66° vs. 118.88°, P<0.001) on postoperative days 1, 3, and 14, as well as severe early-term pain symptoms (pain VAS on postoperative day 3: 7.05 vs. 6.55, P=0.041). However, the LOS, C-reactive protein levels, erythrocyte sedimentation rate (within 2 weeks postoperatively), and HHS were comparable between the groups during the 12 months postoperatively.ConclusionsSuperPath may be a promising, minimally invasive technique for the treatment of OA in the future. Further investigation is necessary to evidence the possible superiority of SuperPath over other conventional mini-incision THA approaches.

Postoperative Limb-Offset Discrepancy Notably Affects Soft-Tissue Tension in Total Hip Arthroplasty.

Inadequate soft-tissue tension in total hip arthroplasty is regarded as one cause of dislocation or abductor muscle weakness. The purpose of the present study was to assess how the postoperative discrepancy in limb offset (consisting of both femoral offset and acetabular offset) affects soft-tissue tension compared with other factors among patients with unilateral hip disease undergoing total hip arthroplasty. A total of 89 consecutive patients underwent mini-incision total hip arthroplasty involving an anterolateral or posterior approach and with use of a computer navigation system. Soft-tissue tension was measured by applying traction amounting to 40% of body weight with the joint positioned at 0°, 15°, 30°, and 45° of flexion. The separation between the cup and the prosthetic head was measured using the navigation system. The cup-head separation differed significantly for varying angles of flexion (p < 0.001), with the greatest distance noted at 15° of flexion (mean and standard deviation, 11 ± 5 mm). Stepwise multiple regression analysis showed that postoperative limb-offset discrepancy, an anterolateral approach, and preoperative abduction range of motion were correlated with the cup-head separation at 15° of flexion. Postoperative limb-offset discrepancy was negatively correlated with the cup-head separation at 0°, 15°, and 30° of flexion. Postoperative limb-offset discrepancy significantly affected the soft-tissue tension in total hip arthroplasty at varying degrees of flexion. This indicated that it is important to restore normal limb offset without overlengthening to obtain adequate soft-tissue tension in total hip arthroplasty. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Posterior mini-incision total hip arthroplasty controls the extent of post-operative formation of heterotopic ossification.

Heterotopic ossification (HO) is the formation of bone at extra-skeletal sites. Reported rates of HO after hip arthroplasty range from 8 to 90 %; however, it is only severe cases that cause problems clinically, such as joint stiffness. The effects of surgical-related controllable intra-operative risk factors for the formation of HO were investigated. Data examined included gender, age of patient, fat depth, length of operation, incision length, prosthetic fixation method, the use of pulsed lavage and canal brush, and component size and material. All cases were performed by the same surgeon using the posterior approach. A total of 510 cases of hip arthroplasty were included, with an overall rate of HO of 10.2 %. Longer-lasting operations resulted in higher grades of HO (p = 0.047). Incisions >10 cm resulted in more widespread HO formation (p = 0.021). No further correlations were seen between HO formation and fat depth, blood loss, instrumentation, fixation methods or prosthesis material. The mini-incision approach is comparable to the standard approach in the aetiology of HO formation, and whilst the rate of HO may not be controllable, a posterior mini-incision approach can limit its extent.

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.

Effects of Anterolateral Minimally Invasive Surgery in Total Hip Arthroplasty on Hip Muscle Strength, Walking Speed, and Functional Score

We conducted this study to observe the difference in muscle strength and walking speed between patients who underwent total hip arthroplasty (THA) in whom an anterolateral mini-incision technique was used and those in whom a conventional approach was used. Fifty-three patients who underwent a mini-incision THA were matched by diagnosis, sex, age, period elapsed since surgery (which ranged from 6 months to 4 years), weight, and height to 53 patients who underwent THA using the conventional anterolateral approach. During the first year after surgery, patients with the mini-incision THA had significantly better hip muscle strength, walking speed, and functional score ( P < .05). At 1 year, the performance characteristics studied were statistically equivalent ( P > .05). Although the mini-incision technique is more difficult than the conventional technique, its use by experienced surgeons can produce quicker short-term recovery.

Durability of Implant Fixation After Less-Invasive Total Hip Arthroplasty

Less-invasive techniques for total hip arthroplasty (THA) have sparked an increased interest among orthopedic surgeons and patients. There has been concern regarding decreased surgical exposure and compromise in prosthesis durability. We present the first long-term outcome of THA performed via the mini-incision posterior approach to show the durability of implant fixation. We compare the clinical and radiographic findings with previously published findings of authors using the same femoral implant and standard surgical techniques over a similar follow-up period. Ninety implants were followed for 10 to 13 years. Clinical evaluation revealed a Harris Hip Score of 92.3. Radiographic evaluation revealed proximal bone atrophy in 57% and lucent lines in 14% of femurs and 11% of cups. Osteolysis was noted in 10% and was associated with polyethylene wear. There were no cases of aseptic stem loosening. Eight polyethylene inserts were revised for wear. These 10-year minimum follow-up findings are consistently comparable with previously published studies using the same implant and larger surgical approaches followed for a similar period. Mini-incision THA technique did not compromise the long-term clinical and radiographic findings when compared with conventional techniques.

Retrieval of a Trial Femoral Head That Displaces into the Periacetabular Soft Tissue During Mini-Incision Total Hip Arthroplasty: A Case Report

The purpose of the present report is to describe the case of a patient in whom a trial femoral head displaced and migrated into the abdomen during a total hip arthroplasty performed with a small incision. We also propose a simple technique to help to prevent such an occurrence. Asixty-four-year-old woman with symptomatic osteoarthritis underwent a right total hip arthroplasty (Fig. 1). The patient was 5 ft (152.4 cm) tall and had a body mass index of 23.4 kg/m2. After a discussion with her, we proposed a mini-incision total hip arthroplasty and she accepted. The patient was informed that data concerning the case would be submitted for publication. With the patient in the lateral decubitus position, an 8-cm anterolateral incision was used to expose the proximal part of the femur and the acetabulum. The Accolade total hip system (Stryker Howmedica Osteonics, Allendale, New Jersey) was used. Following the placement of the acetabular component, the proximal part of the femur was broached and the largest broach that conferred stability was left in place for a trial reduction of the components. A modular trial femoral head was then placed on the trunion of the broach with what was thought to be a secure fit. The broach-head construct was reduced into the acetabular cup. There was a good range of motion without impingement, and the hip was stable. During dislocation of the trial femoral head from the cup, the head became disengaged from the broach and disappeared anteriorly into the soft tissue beneath the rectus femoris muscle. Several unsuccessful attempts were made to retrieve the trial head, first by hand and then with use of a large Kelly clamp …

Operative and Patient Care Techniques for Posterior Mini-incision Total Hip Arthroplasty

Technical and patient care improvements have occurred with the posterior mini-incision total hip arthroplasty. We hypothesized that these changes would provide better results for patients. The clinical and radiographic results of 100 total hip arthroplasties done with the posterior mini incision between January 2004 and October 2004 were compared with 100 mini-incision total hip arthroplasties done between December 2001 and September 2002. There were no differences in diagnosis, age, and body mass index of the patients in each group. Component positions were not compromised in either group. There were improvements in the 2004 group with decreased hospital stay, reduction of postoperative pain and opioid analgesic use, reduced use of assistive devices, and earlier muscle recovery. In the 2004 group there were no complications of infection, dislocation, or sciatic palsy. The posterior mini-incision operation has shown improved results with experience and changes in technique and patient care treatment. Therapeutic study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.

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.

Künstlicher Hüftgelenksersatz über eine posteriore Mini-Inzision - Ergebnisse in 76 aufeinander folgenden Fällen

A refinement of the classic surgical approaches to the hip for total hip arthroplasty (THA) is presently being developed with a drastic shortening of the skin incision. The aim of this study was to explore if a minimal-invasive posterior approach (1) is technically feasible regardless of varying patient anatomy and (2) is associated with such results that do not suggest increased patient risk. We sought to find out how surgical time, blood loss, requirement for pain medication, pain perception and implant position were affected by a posterior mini-incision approach for THA. Prospectively, the results of 76 consecutive THAs operated by the same surgeon via a posterior mini-incision approach were recorded. The length of skin incision ranged from 6.0 to 11.0 cm. On average, surgical time was 83 minutes, intraoperative blood loss was 343 ml, and the amount of PCA-administered Piritramid i. v. in the first 24 hours was 21.4 mg. Pain-free (defined as a 0-10 self rating on a VAS) were 8 % of the patients on day one following mini-incision THA, 41 % on day three, 54 % on day five and 71 % of patients on day seven. The average cup inclination and anteversion were 46 and 13 degrees, stem position was regarded as neutral in 76 %. Complications occurred in 7 patients (9 %). Our posterior mini-incision approach allowed for the placement of 76 consecutive THAs through a skin incision of equal to or less than 11.0 cm in a non-selected population without jeopardising patient safety.

Mini-incision total hip arthroplasty: a quantitative assessment of laboratory data and clinical outcomes

In this study, we used laboratory data and clinical outcomes to evaluate the degree of approach-related trauma in mini-incision arthroplasty. In 94 patients (8 male and 86 female), a total of 100 osteoarthritic joints were replaced using total hip arthroplasty (THA). The level of serum C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) were measured 1 week postoperatively in both the standard group and a mini-incision group. The serum CRP level (mean ± standard deviation) was 3.3 ± 2.6 mg/dl in the standard incision group compared to 1.8 ± 1.2 in the mini-incision group. The ESR level was 66 ± 22mm/h in the standard incision group and 52 ± 20 mm/h in the mini-incision group. The ratio of the level of creatine phosphokinase (CPK) measured postoperatively/preoperatively was 4.7 on the first postoperative day in the standard incision group and 3.6 in the mini-incision group. On the basis of the CRP and ESR levels, the mini-incision THA was considered to be less invasive. However, there was no significant difference in the day 1 CPK ratios between the two groups, suggesting that the degree of muscle trauma was similar.

Mini-incision technique for total hip arthroplasty with navigation

This prospective study compares a mini-incision technique and traditional posterior approach for total hip arthroplasty (THA). Thirty-three patients who had undergone a mini-incision THA were matched by diagnosis, gender, average age, and preoperative Harris Hip Score (HHS) to 33 patients who had undergone THA using the traditional posterior approach. The average length of the incision for group 1 was 11.7 cm (range, 7.3–13.0) and for group 2 was 20.2 cm (range, 14.8–26.0). At the 3-month follow-up, patients in the mini-incision group had significant improvement in limp (P<.05) and ability to climb stairs (P <.01) compared with the traditional group. At the 6 month follow-up, the mini-incision group was significantly better in terms of limp (P <.05), distance walked (P<.001), and stairs (P < 0.001). There was no significant difference between groups for pain, function, or range of motion at the 1-year follow-up examination. Copyright 2003, Elsevier Science (USA). All rights reserved.