Early Pain Relief and Function After Posterior Minimally Invasive and Conventional Total Hip Arthroplasty

Dorr, Lawrence D.; Maheshwari, Aditya V.; Long, William T.; Wan, Zhinian; Sirianni, Leigh Ellen

doi:10.2106/jbjs.f.00940

Cited by 183 publications

(192 citation statements)

References 32 publications

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“…approaches with THA; however, perioperative pain scores and narcotic consumption were not measured. Although it is still controversial whether an abbreviated surgical approach is associated with a faster recovery, less pain, or improved outcomes [7,10,15,21,22,24], our results suggest, similar to the study of Pour et al [21], that perioperative protocols, patient selection, and preoperative education may have a greater effect on early outcomes than the surgical approach. The length of hospitalization was not different between the two groups of patients in our trial.…”

Section: Discussionsupporting

confidence: 81%

“…Along with these alternative surgical approaches have come advanced pathways for perioperative pain management, anesthetic care, and accelerated rehabilitation protocols [4,5,7,21]. The introduction of changes to surgical technique and perioperative protocols in a similar time frame has made it difficult to determine whether the more rapid recovery and decreased pain that have been attributed in some centers with these less invasive approaches are secondary to the surgical approach used, patient selection, or the perioperative protocols followed.…”

Section: Introductionmentioning

confidence: 99%

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

Valle

Dittle

Moric

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background The two-incision approach to THA has been controversial, with some authors reporting its use is associated with a rapid recovery whereas others report no differences in outcomes and a higher risk of perioperative complications secondary to increased surgical complexity. Questions/purposes We therefore compared early postoperative variables including pain, length of stay, functional recovery, complications, and complexity of the mini-posterior and two-incision approaches to THA. Patients and Methods We prospectively enrolled 72 patients scheduled for THA and randomized them into two groups: mini-incision posterior approach and the twoincision approach. Preoperative teaching, anesthetic protocols, implants used, and rehabilitation pathways were identical for both groups. All variables were assessed at a maximum of 1 year postoperatively.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

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

Valle

Dittle

Moric

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…There have been continuing efforts during the past decade to develop minimally invasive surgery techniques for performing THA [2,6,9,10,18,24,30,31]. The purported benefit of minimally invasive THA compared with One of the authors certifies that he (DJR), or a member of his immediate family, has or may receive payments or benefits, in any 1 year, an amount in excess of $100,000.00 from a commercial entity (Greatbatch Medical, Clarence, NY, USA) related to this work.…”

Section: Introductionmentioning

confidence: 99%

“…traditional THA remains controversial [2,3,6,13,23,26]. Proponents of minimally invasive THA cite improved patient satisfaction, less blood loss, shorter hospital stays, and early improved function [2,3,6,13,23,26].…”

Section: Introductionmentioning

confidence: 99%

“…Proponents of minimally invasive THA cite improved patient satisfaction, less blood loss, shorter hospital stays, and early improved function [2,3,6,13,23,26]. However, in the evolution of minimally invasive THA, there has been justified concern regarding the potential for increased complications and the possibility of compromising an already very successful operative procedure [16,19,32].…”

Section: Introductionmentioning

confidence: 99%

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Minimally Invasive Total Hip Arthroplasty Using a Transpiriformis Approach: A Preliminary Report

Roger

Hill

2012

Clinical Orthopaedics &Amp; Related Research

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Background Continuing efforts have been made to develop minimally invasive surgery techniques for THA. One of the most commonly performed of these techniques is the mini-posterior approach. All reported series using this approach describe surgical detachment of the short external rotators of the hip. In 2008, Penenberg et al. described an innovative surgical technique that preserves the short external rotators. We present the results of a singleincision modification of this technique in 135 patients. Description of TechniqueThis technique is based on preservation of all of the short external rotators of the hip with the exception of the piriformis or conjoined tendon. This single-incision technique required the development of specialized instrumentation for exposure and reaming of the acetabulum. The specialized retractors also successfully minimized trauma to the skin and subcutaneous tissue. Methods For the 135 patients undergoing THA with this technique, we analyzed demographic and operative data. We recorded complications, evaluated postoperative clinical function using the Harris hip score, and assessed cup abduction angle, cup anteversion, and stem alignment on radiographs. Minimum followup was 14 months (mean, 22 months; range, 14-33 months). Results There were no dislocations, no sciatic nerve palsies, no wound complications, and low transfusion rates (8%). The postoperative Harris hip score averaged 96.5 (range, 87-100). Overall acetabular cup abduction angle averaged 41°(range, 21°-49°) and anteversion averaged 21°(range, 15°-27°). Four percent and 2% of femoral components were inserted into more than 2°varus and 2°v algus alignment, respectively.

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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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Early Pain Relief and Function After Posterior Minimally Invasive and Conventional Total Hip Arthroplasty

Abstract: Therapeutic Level I.

Cited by 183 publications

References 32 publications

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

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

Minimally Invasive Total Hip Arthroplasty Using a Transpiriformis Approach: A Preliminary Report

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

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