A Prospective Randomized Trial of Mini-incision Posterior and Two-incision Total Hip Arthroplasty

Valle, Craig J. Della; Dittle, Emily; Moric, Mario; Sporer, Scott M.; Buvanendran, Asokumar

doi:10.1007/s11999-010-1491-5

Cited by 33 publications

(31 citation statements)

References 22 publications

(51 reference statements)

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“…The second method to determine mini-incision positioning depends on precise palpation of the greater trochanter. Many authors rely solely on the protrusion of the greater trochanter to start their skin incision, while others associate it with oblique angles varying between 10 and 45° [24][25][26][27][28][29][30][31][32][33]. However, in patients with a large amount of subcutaneous fat at the greater trochanter level, palpation can be difficult or even imprecise.…”

Section: Discussionmentioning

confidence: 99%

Postero-posterolateral approach in total hip arthroplasty

Mokhtar¹

2020

International Orthopaedics (SICOT)

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Introduction Evolving surgical techniques in total hip arthroplasty (THA) have sought to make the surgical procedures safer. This requires having highly reproducible incision landmarks and simplifying the procedures. The postero-posterolateral approach, a very posterior incision in the hip, meets those requirements. However, this has not helped to reduce the postoperative dislocation rate. The aim of this study was to assess the relevance of combining the postero-posterolateral approach and next-generation dual mobility cups (DMC) in terms of dislocation risk. Materials and methods One hundred and fifty-eight THA were performed consecutively using the postero-posterolateral approach on 150 patients, by a single surgeon, over a 49-month period (November 2010 to December 2014). All acetabular implants were impacted. Results Average length of the incision was 7 cm (6 to 9 cm). Mean duration of the surgical procedure was 75 minutes (40 to 100). Mean blood loss was estimated at 210 cc (25 to 410 cc). All patients could walk with assistance the day before transferring to a rehabilitation centre. There was one posterior dislocation (0.63%), without recurrence. Conclusion The straightforwardness and reproducibility of the anatomical landmarks used for the postero-posterolateral approach, added to the stability of the dual mobility cup, result in a safe combination in the therapeutic THA arsenal.

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Section: Discussionmentioning

confidence: 99%

Postero-posterolateral approach in total hip arthroplasty

Mokhtar¹

2020

International Orthopaedics (SICOT)

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“…One study included 3 patients with rheumatoid arthritis [20] and one study included 4 patients with post-traumatic arthritis [39]. Six different surgical approaches were used: anterior (Smith Petersen) [40], anterior minimally invasive [40], lateral/transgluteal (Hardinge/Bauer) [40], posterolateral [41], posterior (Moore/the southern exposure) [40], minimally invasive posterior (miniposterior) [42], and anterolateral (Watson Jones) with or without trochanteric osteotomy [40] (Table 1). The posterior approach was the most common used in 5 studies [12,13,18,21,26].…”

Section: Study Characteristics and Patient Populationsmentioning

confidence: 99%

Abductor Muscle Strength Deficit in Patients After Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

Ismailidis

Kvarda

Vach

et al. 2021

The Journal of Arthroplasty

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Background: The aims of this study were to assess and quantify hip abductor muscle strength deficits after total hip arthroplasty (THA) and to determine associations with external factors. Methods: Studies reporting on hip abductor muscle strength before and/or after THA performed for osteoarthritis or atraumatic osteonecrosis of the hip were considered for inclusion. Data sources were Embase, Medline, and the Cochrane Central Register of Controlled Trials. Muscle strength on the affected side was compared with the healthy contralateral side or with control subjects. Study quality was assessed using a modified Newcastle-Ottawa Scale.Results: Nineteen studies reporting on 875 subjects met the inclusion criteria. Patients scheduled for THA had a mean strength deficit of 18.6% (95% confidence interval (CI) [À33.9, À3.2%]) compared with control subjects. Abductor muscle strength then increased by 20.2% (CI [5.6, 34.8%]) at 4-6 months, 29.6% (CI [4.7, 54.4%]) at 9-12 months, and 49.8% (CI [À31.0, 130.6%]) at 18-24 months postoperatively compared with preoperative values. For unilateral THA, the mean torque ratio was 86.3% (CI [75.4, 97.2%]) and 93.4% (CI [75.1, 111.6%]) before and >24 months after THA, respectively. Study quality was low to moderate. Conclusion: Hip abductor muscle strength deficits may gradually improve during 24 months after THA possibly without complete recovery. Cautious interpretation of these findings is warranted because highquality evidence is largely missing.

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“…On the contrary, a randomized cadaver trial revealed that significantly more muscle mass is damaged by the passage of the rasps and stem during preparation and implantation with the two-incision method versus the mini-posterior technique (gluteus medius, 15.4 vs. 4.7 %, p = 0.0046; gluteus minimus 17.37 vs. 8.62 %, p = 0.002) [5]. A prospective randomized trial comparing the two-incision and mini-incision posterior procedures did not reveal differences in perioperative outcomes between these two approaches [6]. Alecci et al [7] compared intra- and perioperative outcomes in patients undergoing surgery with the minimally invasive direct anterior approach or the standard lateral approach, and reported that the minimally invasive approach provided better perioperative outcomes.…”

Section: Tissue-sparing Surgerymentioning

confidence: 99%

A modified direct lateral approach for neck-preserving total hip arthroplasty: tips and technical notes

Pipino

Cimmino

Palermo

2013

J Orthopaed Traumatol

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Tissue-sparing surgery for hip replacement aims to minimize muscle damage and conserve the femoral neck through the use of mini-prostheses. We propose a modification of the classical direct lateral access procedure that preserves the gluteus medius. Further advantages during the surgical phase include limited blood loss, visualization of the entire acetabulum, and sparing of the transverse ligament. Precise implantation is facilitated and normal biomechanics are preserved. The gluteus medius is divided longitudinally between the anterior third and posterior two-thirds to provide access to the gluteus minimus, which is detached from the femoral insertion together with a small portion of the vastus lateralis, forming a flap that exposes the underlying articular capsule. When the femoral head is revealed, a decision is made to either continue with its dislocation directly or to resect it and remove it separately to avoid damaging the gluteus medius during dislocation. Upon removal of the femoral head, with the limb flexed and slightly over-rotated, the acetabulum is completely visible. Limb length is maintained through the use of reference stitches on the gluteus minimus tendon and the proximal insertion of the vastus lateralis. In keeping with the minimally invasive philosophy, only pathological tissue is removed (marginal osteophytes, geodes, joint capsule, cartilage to the point of bleeding and pulvinar). We have performed more than 2,000 implants with this procedure since 1990. Advantages and potential critical points are discussed.

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A Prospective Randomized Trial of Mini-incision Posterior and Two-incision Total Hip Arthroplasty

Cited by 33 publications

References 22 publications

Postero-posterolateral approach in total hip arthroplasty

Postero-posterolateral approach in total hip arthroplasty

Abductor Muscle Strength Deficit in Patients After Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

A modified direct lateral approach for neck-preserving total hip arthroplasty: tips and technical notes

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