Two-incision THA Had Modest Outcomes and Some Substantial Complications

Pagnano, Mark W.; Leone, James; Lewallen, David G.; Hanssen, Arlen D.

doi:10.1097/01.blo.0000191275.80527.d6

Cited by 111 publications

(50 citation statements)

References 8 publications

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“…Although several reports have raised concern regarding a high risk of complications with the two-incision approach [1,17] and the mini-incision approach [24], in our small series we found both techniques were associated with an acceptable rate of complications, which is in agreement with other studies [5,7,8,10,14,15,19,23]. Pagnano et al [18] also reported a low risk of complications with both approaches as did Duwelius et al [8].…”

Section: Discussionsupporting

confidence: 91%

“…Proponents of these procedures have reported less perioperative blood loss, less pain, and an accelerated recovery [2, 4-8, 19, 22]. Critics have raised concerns that the more limited exposure may negatively affect component position and increase the risk of perioperative complications [1,15,17,24]. There has been particular This study was supported by a grant from Zimmer Inc (Warsaw, IN).…”

Section: Introductionmentioning

confidence: 99%

“…Although reports from some centers have associated this approach with minimal perioperative pain and a rapid recovery [2,5,6,8,19], others have reported a high rate of perioperative complications secondary to the technically demanding nature of the procedure [1,17] and a recovery that is not different from those of modifications of more traditional approaches [18].…”

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: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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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“…In an early report of a consecutive series, the mean time to discharge was shorter for two-incision approach THA patients compared to standard, traditional posterior approach patients at 2.8 days and 5.2 days, respectively [20]. However, the authors noted a rapid rehabilitation protocol or expectations for early hospital discharge were not employed [20]. In a more recent prospective, randomized clinical trial, Pagnano et al [22] reported there was no difference between the two-incision approach and the mini-posterior approach in hospital discharge, with both groups having a mean hospital stay of 2.6 days.…”

Section: Discussionmentioning

confidence: 96%

“…In a prospective, randomized, blinded trial comparing MIS and conventional posterior approach THA, Dorr et al [12] reported a decreased average hospital stay in the MIS group of 63.2 hours compared to 73.6 hours in the traditional approach group. In an early report of a consecutive series, the mean time to discharge was shorter for two-incision approach THA patients compared to standard, traditional posterior approach patients at 2.8 days and 5.2 days, respectively [20]. However, the authors noted a rapid rehabilitation protocol or expectations for early hospital discharge were not employed [20].…”

Section: Discussionmentioning

confidence: 99%

Early Discharge and Recovery with Three Minimally Invasive Total Hip Arthroplasty Approaches: A Preliminary Study

Meneghini

Smits

2009

Clin Orthop Relat Res

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Purported advantages of THA performed with minimally invasive surgical approaches include less muscle damage and faster recovery. The purpose of this preliminary investigation was to determine if differences existed between minimally invasive approaches in hospital discharge and early functional recovery in THA patients with a rapid rehabilitation protocol. Twenty-four consecutive patients were randomized to one of three minimally invasive surgical approaches (two-incision, mini-posterior, and mini-

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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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Two-incision THA Had Modest Outcomes and Some Substantial Complications

Abstract: Prognostic study, Level III (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.

Cited by 111 publications

References 8 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

Early Discharge and Recovery with Three Minimally Invasive Total Hip Arthroplasty Approaches: A Preliminary Study

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

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