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At present, there is still a lack of quality evidence to advocate the expansion of MIHA. The better designed studies suggest that it should even be limited further to recognized expert centres. The complication rates and learning curve may be altered by changes in training and adapting surgical techniques. We emphasize the need for meticulous design in future studies comparing the outcomes of these two procedures.

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Summary: This work discusses some of the benefits, techniques, challenges, and considerations associated with the incorporation of measured surfaces in finite element (FE) models including how much surface data to measure and import into the model, the shape of the surface geometry to create, the presence and effect of surface layers and impurities, the required mesh density for rough surfaces, the nature of the element formulations and material properties at small length scales, the differences between measurement and FE coordinate systems, the limitations and idealizations of the FE method, issues associated with boundary conditions and their ability to impose or prevent conformal contact, and issues associated with the size of the pinball region and the contact stiffness relative to the nature of the surface. It also describes some current and future research directions that can be used to validate and expand existing techniques and to improve our understanding of surface phenomena. SCAN-NING 31: 1-16,