A Lateral Minimal-Incision Technique in Total Hip Replacement: A Prospective, Randomized, Controlled Trial

Speranza, Atillio; Iorio, Raffaele; Ferretti, Matteo; D’Arrigo, Carmelo; Ferretti, Andrea

doi:10.1177/112070000701700102

Cited by 4 publications

(12 citation statements)

References 10 publications

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“…Two high-quality studies and five medium-quality studies reported a moderate to large decrease in operative time for MIS THA [23,27,30,32-34,37]. One other high-quality study and eight medium-quality studies reported no significant difference in operative time [4,17,24-26,28,29,35,36]. …”

Section: Resultsmentioning

confidence: 99%

“…Two high-quality studies [4,34] and eight medium-quality studies [23,25-27,29,33,36,37] reported a small-to-large decrease in intraoperative blood loss after MIS THA. One high-quality study and three medium-quality studies reported no significant difference [24,30,32,35].…”

Section: Resultsmentioning

confidence: 99%

“…Three medium-quality studies reported a moderate-to-large decrease in length of hospital stay after MIS THA [23,26,32]. Two high-quality studies [4,34] and five medium-quality studies [17,24,25,27,36] reported no significant differences in length of stay between the MIS THA group and the control group. None of the studies with CAS THA as study contrast reported data on length of stay.…”

Section: Resultsmentioning

confidence: 99%

“…The high-quality study of Kim [30] reported more acetabular outliers in the study group, but these rates were statistically non-significant. Fewer acetabular outliers were reported in one high-quality study [34] and two medium-quality studies [33,36], though this difference was also non-significant. In addition, one high-quality study [4] and eight medium-quality studies [17,23-29] reported no differences in acetabular outliers.…”

Section: Resultsmentioning

confidence: 99%

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Minimally invasive and computer-navigated total hip arthroplasty: a qualitative and systematic review of the literature

Reininga

Zijlstra

Wagenmakers

et al. 2010

BMC Musculoskelet Disord

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BackgroundBoth minimally invasive surgery (MIS) and computer-assisted surgery (CAS) for total hip arthroplasty (THA) have gained popularity in recent years. We conducted a qualitative and systematic review to assess the effectiveness of MIS, CAS and computer-assisted MIS for THA.MethodsAn extensive computerised literature search of PubMed, Medline, Embase and OVIDSP was conducted. Both randomised clinical trials and controlled clinical trials on the effectiveness of MIS, CAS and computer-assisted MIS for THA were included. Methodological quality was independently assessed by two reviewers. Effect estimates were calculated and a best-evidence synthesis was performed.ResultsFour high-quality and 14 medium-quality studies with MIS THA as study contrast, and three high-quality and four medium-quality studies with CAS THA as study contrast were included. No studies with computer-assisted MIS for THA as study contrast were identified. Strong evidence was found for a decrease in operative time and intraoperative blood loss for MIS THA, with no difference in complication rates and risk for acetabular outliers. Strong evidence exists that there is no difference in physical functioning, measured either by questionnaires or by gait analysis. Moderate evidence was found for a shorter length of hospital stay after MIS THA. Conflicting evidence was found for a positive effect of MIS THA on pain in the early postoperative period, but that effect diminished after three months postoperatively. Strong evidence was found for an increase in operative time for CAS THA, and limited evidence was found for a decrease in intraoperative blood loss. Furthermore, strong evidence was found for no difference in complication rates, as well as for a significantly lower risk for acetabular outliers.ConclusionsThe results indicate that MIS THA is a safe surgical procedure, without increases in operative time, blood loss, operative complication rates and component malposition rates. However, the beneficial effect of MIS THA on functional recovery has to be proven. The results also indicate that CAS THA, though resulting in an increase in operative time, may have a positive effect on operative blood loss and operative complication rates. More importantly, the use of CAS results in better positioning of acetabular component of the prosthesis.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Minimally invasive and computer-navigated total hip arthroplasty: a qualitative and systematic review of the literature

Reininga

Zijlstra

Wagenmakers

et al. 2010

BMC Musculoskelet Disord

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“…There is a lack of consensus over the actual definition of MIS and the relationship between skin incision and soft tissue trauma. Speranza et al [32] and Procyk [33] suggested that the ideal MIS is that of a procedure which has little tissue disruption without cutting muscles and tendons and therefore less pain to provide a significantly shorter rehabilitation with longer-term outcomes which are equal or better to a conventional approach. Accordingly, the little difference in outcomes reported in this metaanalysis may be attributed to similarities in the operative procedure after the skin incision for traditional and MIS procedures.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive versus conventional exposure for total hip arthroplasty: a systematic review and meta-analysis of clinical and radiological outcomes

Smith

Blake

Hing

2010

International Orthopaedics (SICOT)

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Over the past decade, minimally invasive surgery has gained popularity as a means of optimising early postoperative rehabilitation and increasing patient satisfaction and cosmesis following total hip arthroplasty (THA). However, this surgical exposure has also been associated with increased risk of iatrogenic nerve injury and implant mal-positioning due to limited visibility compared to conventionally larger surgical incisions. The purpose of this meta-analysis was to compare the outcomes of these two surgical exposures. A systematic review of the published and unpublished literature was conducted to include all randomised and non-randomised controlled trials comparing the clinical and radiological outcomes of minimally invasive and conventional THA procedures. In total, 28 studies met the eligibility criteria and included 2,849 hips, i.e. 1,428 minimally invasive compared to 1,421 conventional THAs. The meta-analysis of the current evidence base showed that minimally invasive THA is associated with a significantly increased risk of transient lateral femoral cutaneous nerve palsy (p=0.006) with no significantly better outcome.

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Evaluation of Comparative Efficacy and Safety of Surgical Approaches for Total Hip Arthroplasty

Yan

Dong

et al. 2023

JAMA Netw Open

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ImportanceEach approach for primary total hip arthroplasty (THA) has a long learning curve, so a surgeon’s choice to change their preferred approach needs to be guided by clear justifications. However, current evidence does not suggest that any of the THA approaches are more beneficial than others, and the choice of approach is mainly based on the knowledge and experience of the surgeon and individual patient characteristics.ObjectiveTo assess the efficacy and safety associated with different surgical approaches for THA.Data SourcesA comprehensive search of PubMed, EMBASE, and Cochrane databases from inception to March 26, 2022; reference lists of eligible trials; and related reviews.Study SelectionRandomized clinical trials (RCTs) comparing different surgical approaches, including the 2-incision approach, direct anterior approach (DAA), direct lateral approach (DLA), minimally invasive direct lateral approach (MIS-DLA), minimally invasive anterolateral approach (MIS-ALA), posterior approach (PA), minimally invasive posterior approach (MIS-PA), and supercapsular percutaneously assisted total hip arthroplasty (SuperPath), for primary THA.Data Extraction and SynthesisFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, 2 reviewers independently extracted data on study participants, interventions, and outcomes as well as assessed the risk of bias using the Cochrane risk of bias tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A frequentist framework was used to inform a series of random-effects network meta-analyses.Main Outcomes and MeasuresThe outcomes were hip score (range, 0-100, with higher scores indicating better overall hip condition), pain score (range, 0-100, with higher scores indicating more pain), hospitalization time, operation time, quality of life score, blood loss, cup abduction angle, and cup anteversion angle.ResultsOf 2130 retrieved studies, 63 RCTs including 4859 participants (median [IQR] age, 64.0 [60.3-66.5] years; median [IQR] percentage male, 46.74% [38.64%-54.74%]) were eligible for analysis. Eight surgical approaches were evaluated. For hip score, DAA (mean difference [MD], 4.04; 95% CI, 1.92 to 6.16; moderate certainty), MIS-ALA (MD, 3.00; 95% CI, 0.43 to 5.59; moderate certainty), MIS-DLA (MD, 3.37; 95% CI, 1.05 to 5.68; moderate certainty), MIS-PA (MD, 4.46; 95% CI, 1.60 to 7.31; moderate certainty), PA (MD, 4.37; 95% CI, 1.87 to 6.88; high certainty), and SuperPath (MD, 5.00; 95% CI, 0.58 to 9.42; high certainty) were associated with greater improvement in hip score compared with DLA. DLA was associated with lower decrease in pain score than SuperPath (MD, 1.16; 95% CI, 0.13 to 2.20; high certainty) and MIS-DLA (MD, 0.90; 95% CI, 0.04 to 1.76; moderate certainty). PA was associated with shorter operation times compared with 2-incision (MD, −23.85 minutes; 95% CI, −36.60 to −11.10 minutes; high certainty), DAA (MD, −13.94 minutes; 95% CI, −18.79 to −9.08 minutes; moderate certainty), DLA (MD, −10.50 minutes; 95% CI, −16.07 to −4.94 minutes; high certainty), MIS-ALA (MD, −6.76 minutes; 95% CI, −12.86 to −0.65 minutes; moderate certainty), and SuperPath (MD, −13.91 minutes; 95% CI, −21.87 to −5.95 minutes; moderate certainty). The incidence of 6 types of complications did not differ significantly between the approaches.Conclusions and RelevanceIn this study, moderate to high certainty evidence indicated that compared with PA, all surgical approaches except DLA were associated with similar improvements of hip score but longer operation time. DLA was associated with smaller improvement of hip score. The safety of the different approaches did not show significant differences. These findings will help health professionals and patients with better clinical decision-making and also provide references for policy makers.

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A Lateral Minimal-Incision Technique in Total Hip Replacement: A Prospective, Randomized, Controlled Trial

Cited by 4 publications

References 10 publications

Minimally invasive and computer-navigated total hip arthroplasty: a qualitative and systematic review of the literature

Minimally invasive and computer-navigated total hip arthroplasty: a qualitative and systematic review of the literature

Minimally invasive versus conventional exposure for total hip arthroplasty: a systematic review and meta-analysis of clinical and radiological outcomes

Evaluation of Comparative Efficacy and Safety of Surgical Approaches for Total Hip Arthroplasty

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