Mini-posterior Total Hip Arthroplasty Research Articles

A Randomized Clinical Trial of Direct Anterior Versus Mini-Posterior Total Hip Arthroplasty: Small, Early Functional Differences Did Not Lead to Meaningful Clinical Differences at 7.5 Years

BackgroundOur previously reported randomized clinical trial of direct anterior approach (DAA) versus mini-posterior approach (MPA) total hip arthroplasty showed slightly faster initial recovery for patients who had a DAA and no differences in complications or clinical or radiographic outcomes beyond 8 weeks. The aims of the current study were to determine if early advantages of DAA led to meaningful clinical differences beyond 5 years and to identify differences in midterm complications. MethodsOf the 101 original patients, 93 were eligible for follow-up at a mean of 7.5 years (range, 2.1 to 10). Clinical outcomes were compared with Harris Hip, 12-Item Short Form Health Survey, and Hip Disability and Osteoarthritis Outcomes Scores (HOOS) scores and subscores, complications, reoperations, and revisions. ResultsHarris Hip scores were similar (95.3 ± 6.0 versus 93.5 ± 10.3 for DAA and MPA, respectively, P = .79). The 12-Item Short Form Health Survey physical and mental scores were similar (46.2 ± 9.3 versus 46.2 ± 10.6, P = .79, and 52.3 ± 7.1 versus 55.2 ± 4.5, P = .07 in the DAA and MPA groups, respectively). The HOOS scores were similar (97.4 ± 7.9 versus 96.3 ± 6.7 for DAA and MPA, respectively, P = .07). The HOOS quality of life subscores were 96.9 ± 10.8 versus 92.3 ± 16.0 for DAA and MPA, respectively (P = .046). No clinical outcome met the minimally clinically important difference. There were 4 surgical complications in the DAA group (1 femoral loosening requiring revision, 1 dislocation treated closed, and 2 wound dehiscences requiring debridement), and 6 surgical complications in the MPA group (3 dislocations, 2 treated closed, and 1 revised to dual mobility; 2 intraoperative fractures treated with a cable; and 1 wound dehiscence treated nonoperatively). ConclusionsAt a mean of 7.5 years, this randomized clinical trial demonstrated no clinically meaningful differences in outcomes, complications, reoperations, or revisions between DAA and MPA total hip arthroplasty. Level of EvidenceIV.

Pain Control After Total Hip Arthroplasty: A Randomized Controlled Trial Determining Efficacy of Fascia Iliaca Compartment Blocks in the Immediate Postoperative Period

BackgroundThe purpose of this randomized controlled trial is to identify if a fascia iliaca block reduces postoperative pain and narcotic consumption and improves early functional outcomes in primary total hip arthroplasty (THA) performed through the mini-posterior approach. MethodsPatients were recruited from September 2017 to September 2019. Eligible patients received a primary THA using a mini-posterior approach with epidural anesthesia. Postoperatively, patients were randomized to receive a fascia iliaca compartment block or a placebo block. Numeric Rating Scale pain scores, narcotic consumption, and functional outcomes were recorded at regular intervals postoperatively. ResultsUpon study completion, 122 patients were available for final analysis. There was no difference in the average pain scores at any time interval between the placebo and block groups during the first 24 hours (P = .21-.99). There was no difference in the morphine equivalents consumed between the groups during any time interval postoperatively (P = .06-.95). Functional testing showed no difference in regards to distance walked during the first therapy session (67.1 vs 68.3 ft., P = .92) and timed-up-and-go testing (63.7 vs 66.3 seconds, P = .86). There was an increased incidence of quadriceps weakness in the block group (22% vs 0%, P = .004) requiring alterations in therapy protocols. ConclusionThis randomized trial shows that a fascia iliaca compartment block does not improve functional performance and does not decrease pain levels or narcotic usage after mini-posterior THA, but does increase the risk of quadriceps weakness postoperatively. Based on these results we do not recommend routine fascia iliaca compartment blocks after THA performed with the mini-posterior approach.

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.

Same Day Total Hip Arthroplasty Performed at an Ambulatory Surgical Center: 90-Day Complication Rate on 549 Patients

BackgroundThere is an increasing interest in outpatient total hip arthroplasty (THA), as there are perceived benefits to the patient, insurer, and overall healthcare system. However, the safety of outpatient total joint arthroplasty has not been studied. MethodsFive hundred forty-nine patients who underwent mini-posterior THA at a freestanding independent ambulatory surgical center (ASC) were reviewed. All patients were discharged to home on the day of surgery. ResultsThe average age of the patients was 54.4 years (range 27-73). The average American Society of Anesthesiologists score was 1.6 (range 1-3). Of the 549 patients, 3 (0.5%) admitted from the surgery center to our local hospital. One patient was admitted for pain control after failing to disclose his long-term high-dose narcotic dependence, one patient was admitted for an acetabular component migration identified on postoperative x-ray, and one patient was admitted for hypotension, bradycardia, and an acute polyarthralgia exacerbation. An additional patient was seen 2 days after surgery in a local emergency department for oversedation secondary to narcotics and later discharged to home. ConclusionOutpatient THA at an ASC is safe and effective when performed on the appropriately indicated patient. There were 4 visits to the hospital within 2 days of surgery. Only 1 was related to medical events, 2 were pain control and/or medication-related and the final was technique-related.Known orthopedic complications including infection, dislocation, and deep vein thrombosis appear consistent with the literature for a series of this size.Same day discharge THA in an ASC is safe and reproducible.

Deep Venous Thrombosis after Mini-Posterior Total Hip Arthroplasty in Japanese Patients

We conducted a retrospective study of the occurrence of deep venous thrombosis (DVT) following mini-posterior total hip arthroplasty (THA) in Japanese patients. From May 2004 to December 2009 mini-posterior THA was performed on 1659 cases, of whom 603 cases didn't receive anticoagulants (Group 1), 547 cases received 2.5 mg percutaneous injection of fondaparinux (a factor Xa inhibitor) daily for 7 days starting the day after surgery (Group 2), and 509 cases received 2000 IU percutaneous injection of enoxaparin (low-molecular-weight heparin) twice daily for 7 days starting the day after surgery (Group 3). The baseline characteristics were very similar in each group. All patients started walking the day after surgery, were advised to wear graduated compression stockings for six weeks after the operation, and used a foot pump for 3 hours a day postoperatively for several days. A week after surgery Duplex ultrasound with colour-flow Doppler imaging of the lower extremities was performed. The occurrence of DVT was significantly different between Groups 1, 2, and 3 (p<0.001): 57 cases (9.5%), 4 cases (0.7%), and 0 cases (0%), respectively. No patients of any group had clinically detected pulmonary emboli. In this study we showed that adding anticoagulants with foot pumps further reduced the incidence of DVT, which seldom occurs following less invasive mini-posterior THA combined with early mobilisation, foot pumps, and anticoagulants.

No Benefit of the 2-Incision Technique Over Miniposterior Total Hip Arthroplasty: A Comprehensive Gait Analysis and Strength Testing Study

Two-incision total hip arthroplasty (THA) advocates have touted that the recovery after that procedure is dramatically quicker than that after other methods of performing THA. A comprehensive gait analysis and strength testing study that directly compares the 2-incision technique versus another method of THA has not been done in similar groups of patients.

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.

Patients Preferred a Mini-Posterior Total Hip Arthroplasty Over a Contralateral Two-Incision Total Hip Arthroplasty: Results in Patients Treated with the Same Anesthetic and Rehab Protocol

Much attention has been given to the purported early functional benefits of a so-called two-incision total hip arthroplasty (THA) approach. Most of the reports to date, however, are on selected patients who were treated with advanced anesthetic and rehabilitation protocols that make comparison with historical data difficult. We have had a broad experience with the two-incision THA and now have a subgroup of patients who have had a two-incision THA on one side and a mini-posterior THA done on the contralateral side with the same anesthetic and rehabilitation protocol.

THE FRANK STINCHFIELD AWARD: Muscle Damage after Total Hip Arthroplasty Done with the Two-incision and Mini-posterior Techniques

Some surgeons have suggested that a minimally invasive two-incision approach allows total hip arthroplasty to be done without cutting or damaging any muscle or tendon. To our knowledge that claim has not been supported by any published clinical or basic science data. Our purpose in doing this study was to quantify the extent and location of damage to the abductor and external rotator muscles and tendons after two-incision and mini-posterior total hip arthroplasty. Ten cadavers (20 hips) were studied. In each cadaver one hip randomly was assigned to the two-incision group and the contralateral hip was assigned to the mini-posterior group. After inserting the total hip arthroplasty components the muscle damage was assessed using a technique described previously. Damage to the muscle of the gluteus medius and gluteus minimus was substantially greater with the two-incision technique than with the mini-posterior technique. Every two-incision total hip replacement caused measurable damage to the abductors, the external rotators, or both. Every mini-posterior hip replacement caused the external rotators to detach during the exposure and had additional measurable damage to the abductor muscles and tendon. We do not support the contention that a two-incision total hip arthroplasty is done without cutting muscle or tendon. None of the two-incision hip replacements were done without cutting, reaming, or damaging the gluteus medius or gluteus minimus muscle or external rotators.