Early outcomes following minimally invasive total hip arthroplasty using a two-incision approach versus a mini-posterior approach

Abstract

We evaluated early clinical results and radiographic findings of MIS THA using 2-incsion approach and mini-posterior approach. A consecutive series of 35 patients (40 hips) with 2-incision THA and a consecutive series of 35 patients (36 hips) with mini-posterior THA performed in the same period were evaluated. The patient groups were not randomised. At the mean follow-up of 20.2 months (range, 12-36 months), the 2-incision group had significantly earlier ambulation, driving ability and return to work. However, it had significantly more operative time, blood loss, blood transfusion and complications. Regarding radiographic findings of 2-incision group and mini-posterior group, the mean radiographic acetabular abduction of was 46.7 degrees (89% was within 35- 55) and 44.8 degrees (84% was within 35-55), respectively. The femoral stem was in neutral position in 80% and 83%, respectively. There was no statistical difference of the implant position between groups. Although MIS 2-incison THA provided faster, early ambulation than the mini-posterior THA, surgeons have to weigh the advantages and disadvantages of this technique including, increased operative time, blood loss and their familiarity with similar standard incisions and landmarks.

No Strength or Gait Benefit of Two-incision THA: A Brief Followup at 1 Year

“…Therefore, there were 21 patients with complete preoperative and 2-month postoperative gait analyses and strength testing, and 19 patients with complete preoperative and 1-year postoperative gait analyses and strength testing. The 19 patients included 11 men and eight women with a mean (± SD) age of 65 ± 12 years (range, 40-85 years) and a mean BMI of 29 ± 5 (range, [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. Eleven patients had the two-incision surgical technique and eight had the mini-posterior technique.…”

“…Without suitable controls, it is unclear whether the observed recovery in those reports was attributable to the two-incision technique or to some combination of patient selection, patient education, changes in perioperative analgesia protocols, or rapid rehabilitation protocols [12,25,26,28]. Furthermore, there is a growing body of evidence of increased complication rates with the two-incision minimally invasive technique when compared with other methods [1,31,35]. This has persisted even beyond the learning curve of the individual surgeon [9,27].…”

Factors contributing to rehabilitation outcomes following hip arthroplasty

“…Most patients undergoing HA are of working age and are able to return to work by 3-7 weeks, and can gradually return to athletic activity after about 3-6 months as long as all post-operative guidelines are followed. 43,[58][59][60][61] A paucity of evidence exists to best determine the association of factors such as patient ethnicity, home environment or support system, specific physical therapy protocols, or the use of manual therapy on outcomes following HA. Without a base of evidence for these variables, the therapist is unable to extrapolate useful clinical information outside of their own personal experiences or sharing of information from others.…”

“…According to a review by Kuijer et al, 60 a patient's ability to return to work post-operatively reduces economic burden as well as improves the patient's economic situation. Tanavalee et al 61 found that a two-incision approach versus a mini-posterior allowed for earlier return to work following HA. Any surgical approach with post-operative restrictions is likely to lead to delayed return to work with greater restrictions leading to a longer period out of work.…”

A systematic review of the clinical effectiveness and cost-effectiveness and economic modelling of minimal incision total hip replacement approaches in the management of arthritic disease of the hip

“…Fifty-four papers (43 full text papers 17,27-68 and 11 abstracts [69][70][71][72][73][74][75][76][77][78][79] ) met the inclusion criteria for the review. In addition, relevant data were supplemented by a published registry report (Norwegian Arthroplasty Register) 11 31,32,40,43,46,58,69,75,77 17 comparative studies, [28][29][30][33][34][35][36]42,44,45,48,52,[54][55][56]74,78 and six case series or registry; 11,39,41,[49][50][51] one was used for the comparison of two mini-incision THR with standard THR (one trial) 57 and nine were relevant to the comparison of two mini-incision with single mini-incision THR, including two trials, 72,73 five comparative studies 38,47,53,71,79 and two case…”