Minimal Access Surgery for Total Hip Arthroplasty – Current Beliefs and Activity Profile in The UK

Abstract

INTRODUCTION There is a strong drive from patients, industry and the media to perform total hip arthroplasty (THA) through a minimal access incision. Currently in the UK, the exact definition and uptake of this procedure is not known.PATIENTS AND METHODS A postal questionnaire was sent to all consultant orthopaedic surgeons in the UK registered with the British Orthopaedic Association.RESULTS Of those performing THA, 23% have performed minimal access hip surgery (MAS). Of users, 63% perform less than 20 cases per year, 62% use the mini-posterior approach, and 12% intend to perform MAS in the future. There is an association with specialisation. The mean and mode scar sizes for MAS were 9.9 cm and 10 cm, respectively.CONCLUSIONS MAS is increasing in popularity but is currently performed in small numbers by those with a specialist interest in hip arthroplasty. Because no long-term results have been published regarding this procedure, it will be important to ensure that standards of implantation are not jeopardised and training remains critical. Cases should be registered with the National Joint Registry using the current definition of scar size less than 10 cm.

Global mapping of institutional and hospital-based (Level II–IV) arthroplasty registries: a scoping review

“…According to the study type, 485 (74.85%) were cohorts [ 2 , 3 , 8 – 12 , 14 – 316 ], 91 (14.04%) were case-series [ 13 , 317 – 406 ], 49 (7.56%) were case–control studies [ 407 – 455 ], nine (1.39%) cross-sectional studies [ 456 – 464 ], eight (1.23%) protocols for registry-based studies [ 465 – 472 ] and six (0.93%) randomised control trials (RCT) [ 473 – 478 ]. Three hundred twenty-seven cohort studies were retrospective [ 2 , 8 , 11 , 14 , 17 , 18 , 21 – 26 , 29 – 34 , 36 , 38 , 41 , 42 , 44 – 46 , 54 – 56 , 64 – 71 , 83 – 91 , 106 – 118 , 123 , 137 – 146 , 155 – 190 , 200 – 217 , 233 – 266 , 273 , 281 – 308 , 311 – 315 , 479 – 590 ], and 158 were prospective [ 9 , 10 , 12 , 15 , 16 , 19 , 20 , …”

Minimally invasive surgery for total hip arthroplasty

“…For example, the United Kingdom National Joint Registry has defined MIS as an incision length of 10 cm or less. 3 Siddiqui et al 4 defined MIS as reduction of the amount of deep dissection and the length of the skin incision. MIS approaches may be broadly classified into two main categories: small-incision and modified deep-dissection approaches.…”

“…That study also found that 63% of the orthopaedic surgeons with MIS experience used MIS in fewer than 20 patients per year, and that 62% of those surgeons used the mini-posterior approach. 3 In the second study, 23 an outpatient clinic survey revealed that patients still consider complication rates and implant survival to be more important than length of rehabilitation, length of hospital stay and length of scar, in that order. However, MIS for THA was popular among the patients surveyed, and most indicated they would choose MIS even in the absence of information on complications and outcomes.…”

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

“…106 Moreover, some surgeons may have been using a progressively shorter incision in standard THR for many years. 107 Indeed, most of the included studies reported using average incision length of around 20 cm or less for the standard incision group. Hence measurable improvements with further shortening of incisions to less than 10 cm might be expected to be relatively small.…”

“…However, it has been argued by some that reduction in the dissection of soft tissue is more important with the less invasive approaches rather than incision length itself. 107,108 Yet it is not always clear within the included studies whether the deep dissection was sufficiently different between the mini-incision and standard incision groups. Of note, the cadaver study by Mardones and colleagues 109 comparing the two-incision technique with a single miniincision technique reported that the degree of damage to the abductor muscle was actually greater with the two-incision incision technique.…”