Reducing incision length or intensifying rehabilitation: what makes the difference to length of stay in total hip replacement in a UK setting?

Peck, C. N.; Foster, Andrew L.; McLauchlan, G.

doi:10.1007/s00264-006-0091-1

Cited by 15 publications

(8 citation statements)

References 17 publications

(19 reference statements)

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“…Surgical approach has not affected outcome of hip resurfacing [33]. Aggressive rehabilitation and not incision length apparently shortens recovery [48]. Multimodal pain management and aggressive rehabilitation achieve comparable early outcome with standard incision as with mini-incision arthroplasty [40].…”

Section: Discussionmentioning

confidence: 99%

“…Minimally invasive approaches do not apparently make a difference in gait parameters at 3 months after surgery [63]. The current literature suggests that accelerated physiotherapy and revised pain protocols have made differences in recovery independent of the length of surgical incision [40,48,50]. Multimodal pain management has improved pain scores related to activity, decreased narcotic consumption, and enhanced physical therapy participation [16,29,49].…”

Section: Discussionmentioning

confidence: 99%

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Factors Influencing Early Rehabilitation After THA: A Systematic Review

Sharma

Morgan

Cheng

2009

Clin Orthop Relat Res

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A wide variation exists in rehabilitation after total hip arthroplasty (THA) in part due to a paucity of evidence-based literature. We asked whether a minimally invasive surgical approach, a multimodal approach to pain control with revised anesthesia protocols, hip restrictions, or preoperative physiotherapy achieved a faster rehabilitation and improved immediate short-term outcome. We conducted a systematic review of 16 level I and II studies after a strategy-based search of English literature on OVID Medline, PubMed, CINAHL, Cochrane, and EMBASE databases. We defined the endpoint of assessment as independent ambulation and ability to perform activities of daily living. Literature supports the use of a multimodal pain control to improve patient compliance in accelerated rehabilitation. Multimodal pain control with revised anesthesia protocols and accelerated rehabilitation speeds recovery after minimally invasive THA compared to the standard approach THA, but a smaller incision length or minimally invasive approach does not demonstrably improve the short-term outcome. Available studies justify no hip restrictions following an anterolateral approach but none have examined the question for a posterior approach. Preoperative physiotherapy may facilitate faster postoperative functional recovery but multicenter and welldesigned prospective randomized studies with outcome measures are necessary to confirm its efficacy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Factors Influencing Early Rehabilitation After THA: A Systematic Review

Sharma

Morgan

Cheng

2009

Clin Orthop Relat Res

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“…Of the eight studies evaluating the effect of a weekend AH service, all considered the effect of PT alone and five compared a 5-day to a 7-day service 36,37,39,42,44 . Two studies compared a 6 to a 7-day service 41,49 while one compared a 5 to a 6-day service 48 .…”

Section: Effects Of a Weekend Servicementioning

confidence: 99%

Early commencement of physical therapy in the acute phase following elective lower limb arthroplasty produces favorable outcomes: a systematic review and meta-analysis examining allied health service models

Haas

Sarkies

Bowles

et al. 2016

Osteoarthritis and Cartilage

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“…But obviously, these patients are not as sensitive to muscular trauma and they possess sufficient regenerative capacity. This would also explain that a number of comparative studies were not able to find any significant difference in the clinical outcome between patients who underwent THA through a minimally invasive or a traditional approach [7,8,[27][28][29][30]. The controversial discussion about the advantage of minimally invasive THA which has arisen in recent years, therefore gains a new aspect.…”

Section: Discussionmentioning

confidence: 99%

Age-related appearance of muscle trauma in primary total hip arthroplasty and the benefit of a minimally invasive approach for patients older than 70 years

Müller

Tohtz

Dewey

et al. 2010

International Orthopaedics (SICOT)

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Old age is frequently associated with a poorer functional outcome after THA. This might be based upon muscular damage resulting from surgical trauma. Minimally invasive approaches have been widely promoted on the basis of the muscle sparing effect. The aim of the study was to evaluate of the functional outcome and the grade of fatty muscle atrophy of the gluteus medius muscle by magnetic-resonance-imaging (MRI) in patients undergoing minimally invasive or traditional THA. Forty patients (21 female, 19 male) underwent THA either via a modified direct lateral (mDL) or a minimally invasive anterolateral (ALMI) approach. Patients were evaluated clinically and by MRI in terms of age (< or ≥70 y) preoperatively and at three and 12 months postoperatively. The Harris hip score and Trendelenburg's sign were recorded and a survey of a pain (using a numeric rating scale of 0-10) and satisfaction score (using a numeric rating scale of 1-6) was performed. Fatty atrophy (FA) of gluteus medius muscle was rated by means of a five-point rating scale (0 indicates no fat and 4 implies more fat than muscle). Younger patients reached a significantly higher Harris hip score, lower pain score and lower rate of positive Trendelenburg's sign accompanied by a significantly lower rate of postoperative FA (P = 0.03; young: FA (MW) = (preop. / 3 / 12 months), 0.15 / 0.7 / 0.7; old: FA (MW) = 0.18 / 1.3 / 1.36). Older patients with an mDL-approach had the significantly lowest clinical scores, the highest rate of positive Trendelenburg's sign and also the highest rate of fatty atrophy (P = 0.03; FA (old) mDL: 1.8; ALMI: 0.7). Interestingly, no influence of the approach could be detected within the younger group. Patients older than 70 years had a poorer functional outcome and a higher postoperative extent of FA when compared to younger patients, which must be based upon a higher vulnerability and a reduced regenerative capacity of their skeletal muscle. Through a minimally invasive approach the muscle trauma in older patients can be effectively reduced and thus the functional outcome significantly improved. Incision and detachment of tendons and muscles should be strictly avoided.

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Reducing incision length or intensifying rehabilitation: what makes the difference to length of stay in total hip replacement in a UK setting?

Cited by 15 publications

References 17 publications

Factors Influencing Early Rehabilitation After THA: A Systematic Review

Factors Influencing Early Rehabilitation After THA: A Systematic Review

Early commencement of physical therapy in the acute phase following elective lower limb arthroplasty produces favorable outcomes: a systematic review and meta-analysis examining allied health service models

Age-related appearance of muscle trauma in primary total hip arthroplasty and the benefit of a minimally invasive approach for patients older than 70 years

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