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.

Is two‐incision approach superior to the mini‐posterior approach in total hip arthroplasty?: a meta‐analysis

“…As depicted in Figure 3a, two studies including 148 patients reported the operative time along with SD 19,20 . The data was analysed using a random effect model due to the existence of significant heterogeneity ( P < 0.00001, I 2 = 96%).…”

“…Compared with the mini‐posterior THA, patients receiving the two‐incision THA suffered from reduced operative blood loss significantly (MD = 73.07, 95% CI 6.57–139.57, P = 0.03). In one included study, Tanavalee et al 19 . found that patients in the two‐incision group showed increased operative time than the mini‐posterior group (mean 55.00; 95% CI 46.43–63.57).…”

“…The function recovery time to walk with aids along with SD was reported in four studies 14,17,19,20 . With no evidence of significant heterogeneity ( P = 0.29, I 2 = 19%), a fixed‐effect model was utilized to analyse the pooled results.…”

Total Hip Arthroplasty Using Two-Incision Technique

“…Tanavalee et al19) reported that two-incision THA required long operation time and resulted in massive blood loss. In the study by Yoon et al,11) there was no difference in the mean operation time between the conventional method and single-incision MIS, but it took 20 more minutes with two-incision MIS.…”

Why Minimally Invasive Surgery in Hip Arthroplasty?

“…Cup dislodgment reported was a mistake of the surgeon and not a real complication of the technique as he felt self-confident with the acetabulum purchase without testing the grip of the cup. Rapid early return to function related to minimally invasive surgery (Duwelius & Dorr, 2008;Khan et al, 2006;Seng et al, 2009) has been reported in many papers but these techniques have shown increase complications, especially with the two-incision technique (Desser et al, 2010;Pagnano et al, 2005;Tanavalee et al, 2006). Mini-posterior and direct anterior approach report show rapid recovery function for patients (Duwelius & Dorr, 2008;Klausmeier et al, 2010;Lin et al, 2007;Mardones et al, 2005;Procyk, 2007;Stehlík et al, 2008) but these were limited to the early experience of a few surgeons.…”