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Minimally invasive total hip arthroplasty: a systematic review

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Abstract

The purpose of this study was to compare the operative outcome between mini and standard incisions in total hip arthroplasty (THA). We identified 12 randomised or quasi-randomised control trials (RCT or qRCT) published between 1996 and 2008. Subgroup and sensitivity analyses were performed to evaluate the differences in results for surgical approach, trial quality, and follow-up duration. Operative time and blood loss were significantly reduced in the mini-incision group for studies with the posterior or posterolateral approach. Concerning postoperative complications, there were no significant differences between the two groups with no significant heterogeneity. No differences were observed between the two groups for Harris hip score and radiographic results except for cup anterversion. Although mini-incision appeared to have similar outcomes compared to standard incision, the follow-up is short-term according to current standards in THA. High-quality studies are required to compare the outcomes of these two procedures.

Resumé

Le but de cette étude est de comparer le devenir opératoire des patients ayant bénéficié d'une prothèse totale de hanche par voie mini-invasive ou par incision standard. Nous avons identifié 12 publications d'essais randomisés ou quasi randomisés (RCT ou qRCT) publiées entre 1996 et 2008. Des sous-groupes ont été réalisés de façon à évaluer la différence des résultats selon l'approche chirurgicale, la qualité des essais et la durée du suivi. Le temps opératoire et les pertes sanguines étaient significativement moins importants dans le groupe mini-incision réalisé par voie postérieure ou postéro-latérale. Il n'y a pas de différence significative dans les complications postopératoires entre les deux groupes de même en ce qui concerne le score de Harris, les résultats radiologiques exceptés pour l'antéversion de la cupule. Cependant, la mini incision semble avoir un devenir comparable à l'incision standard, mais avec des suites plus rapides. Des études ultérieures de grande qualité seront nécessaires pour comparer le devenir de ces deux procédés.

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References

  1. Archibeck MJ, White RE Jr (2004) Learning curve for the two-incision total hip replacement. Clin Orthop Relat Res 429:232–238

    Article  PubMed  Google Scholar 

  2. Aziz O, Rao C, Panesar SS, Jones C, Morris S, Darzi A (2007) Meta-analysis of minimally invasive internal thoracic artery bypass versus percutaneous revascularisation for isolated lesions of the left anterior descending artery. BMJ 334:617

    Article  PubMed  Google Scholar 

  3. Berger RA, Jacobs JJ, Meneghini RM, Della Valle C, Paprosky W, Rosenberg AG (2004) Rapid rehabilitation and recovery with minimally invasive total hip arthroplasty. Clin Orthop Relat Res 429:239–247

    Article  PubMed  Google Scholar 

  4. Bottner F, Delgado S, Sculco TP (2006) Minimally invasive total hip replacement: the posterolateral approach. Am J Orthop 35:218–224

    PubMed  Google Scholar 

  5. Callaghan J (2006) Skeptical perspectives on minimally invasive total hip arthroplasty. J Bone Joint Surg Am 85:2242–2243

    Google Scholar 

  6. Cameron HU (2002) Mini-incisions: visualization is key. Orthopedics 25:473

    PubMed  Google Scholar 

  7. Chan AW, Hróbjartsson A, Haahr MT, Gøtzsche PC, Altman DG (2004) Empirical evidence for selective reporting of outcomes in randomized trials: comparison of protocols to published articles. JAMA 291:2457–2465

    Article  CAS  PubMed  Google Scholar 

  8. Chimento GF, Pavone V, Sharrock N, Kahn B, Cahill J, Sculco TP (2005) Minimally invasive total hip arthroplasty: a prospective randomized study. J Arthroplasty 20:139–144

    Article  PubMed  Google Scholar 

  9. Chung WK, Liu D, Foo LS (2004) Mini-incision total hip replacement-surgical technique and early results. J Orthop Surg (Hong Kong) 12:19–24

    CAS  Google Scholar 

  10. de Beer J, Petruccelli D, Zalzal P, Winemaker MJ (2004) Single-incision, minimally invasive total hip arthroplasty: length doesn't matter. J Arthroplasty 19:945–950

    PubMed  Google Scholar 

  11. DiGioia AM 3rd, Plakseychuk AY, Levison TJ, Jaramaz B (2003) Mini-incision technique for total hip arthroplasty with navigation. J Arthroplasty 18:123–128

    Article  PubMed  Google Scholar 

  12. Dorr LD, Maheshwari AV, Long WT, Wan Z, Sirianni LE (2007) Early pain relief and function after posterior minimally invasive and conventional total hip arthroplasty. A prospective, randomized, blinded study. J Bone Joint Surg Am 89:1153–1160

    Article  PubMed  Google Scholar 

  13. Dutka J, Sosin P, Libura M, Skowronek P (2007) Total hip arthroplasty through a minimally invasive lateral approach-our experience and early results. Orthop Traumatol Rehabil 9:39–45

    Google Scholar 

  14. Flören M, Lester DK (2006) Durability of implant fixation after less-invasive total hip arthroplasty. J Arthroplasty 21:783–790

    Article  PubMed  Google Scholar 

  15. Hart R, Stipcák V, Janecek M, Visna P (2005) Component position following total hip arthroplasty through a miniinvasive posterolateral approach. Acta Orthop Belg 71:60–64

    PubMed  Google Scholar 

  16. Higgins JPT, Green S (2008) Cochrane handbook for systematic reviews of interventions version 5.0. The Cochrane Collaboration

  17. Howell JR, Garbuz DS, Duncan CP (2004) Minimally invasive hip replacement: rationale, applied anatomy, and instrumentation. Orthop Clin North Am 35:107–118

    Article  PubMed  Google Scholar 

  18. Howell JR, Masri BA, Duncan CP (2004) Minimally invasive versus standard incision anterolateral hip replacement: a comparative study. Orthop Clin North Am 3:153–162

    Article  Google Scholar 

  19. Ilizaliturri VM Jr, Chaidez PA, Valero FS, Aguilera JM (2004) Small incision total hip replacement by the lateral approach using standard instruments. Orthopedics 27:377–381

    PubMed  Google Scholar 

  20. Jacobs WC, Clement DJ, Wymenga AB (2005) Retention versus removal of the posterior cruciate ligament in total knee replacement: a systematic literature review within the Cochrane framework. Acta Orthop 76:757–768

    Article  PubMed  Google Scholar 

  21. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary. Control Clin Trials 17:1–12

    Article  CAS  PubMed  Google Scholar 

  22. Keener JD, Callaghan JJ, Goetz DD, Pederson D, Sullivan P, Johnston RC (2003) Long-term function after Charnley total hip arthroplasty. Clin Orthop Relat Res 417:148–156

    PubMed  Google Scholar 

  23. Kim YH (2006) Comparison of primary total hip arthroplasties performed with a minimally invasive technique or a standard technique: a prospective and randomized study. J Arthroplasty 21:1092–1098

    Article  PubMed  Google Scholar 

  24. Kiyama T, Naito M, Shitama H, Shinoda T, Maeyama A (2008) Comparison of skin blood flow between mini-and standard-incision approaches during total hip arthroplasty. J Arthroplast 23:1045–1049

    Article  Google Scholar 

  25. Klein GR, Parvizi J, Sharkey PF, Rothman RH, Hozack WJ (2005) Minimally invasive total hip arthroplasty: internet claims made by members of the Hip Society. Clin Orthop Relat Res 441:68–70

    Article  PubMed  Google Scholar 

  26. Labovitch RS, Bozic KJ, Hansen E (2006) An evaluation of information available on the internet regarding minimally invasive hip arthroplasty. J Arthroplasty 21:1–5

    Article  PubMed  Google Scholar 

  27. Laffosse JM, Chiron P, Molinier F, Bensafi H, Puget J (2007) Prospective and comparative study of the anterolateral mini-invasive approach versus minimally invasive posterior approach for primary total hip replacement—early results. Int Orthop 31:597–603

    Article  CAS  PubMed  Google Scholar 

  28. Levine BR, Klein GR, Di Cesare PE (2007) Surgical approaches in total hip arthroplasty: a review of the mini-incision and MIS literature. Bull NYU Hosp Jt Dis 65:5–18

    PubMed  Google Scholar 

  29. Malik A, Dorr LD (2007) The science of minimally invasive total hip arthroplasty. Clin Orthop Relat Res 463:74–84

    PubMed  Google Scholar 

  30. McAuley JP, Szuszczewicz ES, Young A, Engh CA Sr (2004) Total hip arthroplasty in patients 50 years and younger. Clin Orthop Relat Res 418:119–125

    Article  PubMed  Google Scholar 

  31. Mow CS, Woolson ST, Ngarmukos SG, Park EH, Lorenz HP (2005) Comparison of scars from total hip replacements done with a standard or a mini-incision. Clin Orthop Relat Res 441:80–85

    Article  PubMed  Google Scholar 

  32. Murphy SB, Ecker TM, Tannast M (2006) THA performed using conventional and navigated tissue-preserving techniques. Clin Orthop Relat Res 453:160–167

    Article  PubMed  Google Scholar 

  33. Musil D, Stehlík J, Verner M (2008) A comparison of operative invasiveness in minimally invasive anterolateral hip replacement (MIS-AL) and standard hip procedure, using biochemical markers. Acta Chir Orthop Traumatol Cech 75:16–20

    CAS  PubMed  Google Scholar 

  34. Nakamura S, Matsuda K, Arai N, Wakimoto N, Matsushita T (2004) Mini-incision posterior approach for total hip arthroplasty. Int Orthop 28:214–217

    Article  PubMed  Google Scholar 

  35. Ogonda L, Wilson R, Archbold P, Lawlor M, Humphreys P, O’Brien S, Beverland D (2005) A minimal-incision technique in total hip arthroplasty does not improve postoperative outcomes. A prospective, randomized, controlled trial. J Bone Joint Surg Am 87(4):701–710

    Article  PubMed  Google Scholar 

  36. Petitti DB (2001) Approaches to heterogeneity in meta-analysis. Stat Med 20:3625–3633

    Article  CAS  PubMed  Google Scholar 

  37. Prescott RJ, Counsell CE, Gillespie WJ, Grant AM, Russell IT, Kiauka S, Colthart IR, Ross S, Shepherd SM, Russell D (1999) Factors that limit the quality, number and progress of randomized controlled trials. Health Technol Assess 3:1–143

    CAS  PubMed  Google Scholar 

  38. Procyk S (2007) Initial results with a mini-posterior approach for total hip arthroplasty. Int Orthop 31(Suppl 1):S17–S20

    Article  PubMed  Google Scholar 

  39. Purkayastha S, Tilney HS, Georgiou P, Athanasiou T, Tekkis PP, Darzi AW (2007) Laparoscopic cholecystectomy versus mini-laparotomy cholecystectomy: a meta-analysis of randomised control trials. Surg Endosc 21:1294–1300

    Article  PubMed  Google Scholar 

  40. Reininga IH, Wagenmakers R, van den Akker-Scheek I, Stant AD, Groothoff JW, Bulstra SK, Zijlstra W, Stevens M (2007) Effectiveness of computer-navigated minimally invasive total hip surgery compared to conventional total hip arthroplasty: design of a randomized controlled trial. BMC Musculoskelet Disord 11:4

    Article  Google Scholar 

  41. Sculco TP, Jordan LC, Walter WL (2004) Minimally invasive total hip arthroplasty: The Hospital for Special Surgery experience. Orthop Clin North Am 35(2):137–142

    Article  PubMed  Google Scholar 

  42. Sherry E, Egan M, Henderson A, Warnke PH (2002) Minimally invasive techniques for total hip arthroplasty. J Bone Joint Surg Am 84:1481

    PubMed  Google Scholar 

  43. Speranza A, Iorio R, Ferretti M, Arrigo CD, Ferretti A (2007) A lateral minimal-incision technique in total hip replacement: a prospective, randomizes, controlled trial. Hip Int 17:4–8

    CAS  PubMed  Google Scholar 

  44. Swanson TV (2007) Posterior single-incision approach to minimally invasive total hip arthroplasty. Int Orthop 31(Suppl 1):S1–S5

    Article  PubMed  Google Scholar 

  45. Szendrõi M, Sztrinkai G, Vass R, Kiss J (2006) The impact of minimally invasive total hip arthroplasty on the standard procedure. Int Orthop 30:167–171

    Article  PubMed  Google Scholar 

  46. Teet JS, Skinner HB, Khoury L (2006) The effect of the “mini” incision in total hip arthroplasty on component position. J Arthroplasty 21:503–507

    Article  PubMed  Google Scholar 

  47. Vavken P, Kotz R, Dorotka R (2007) Minimally invasive hip replacement—a meta-analysis. Z Orthop Unfall 145:152–156

    Article  CAS  PubMed  Google Scholar 

  48. Wenz JF, Gurkan I, Jibodh SR (2002) Mini-incision total hip arthroplasty: a comparative assessment of perioperative outcomes. Orthopedics 25:1031–1043

    PubMed  Google Scholar 

  49. Wright JM, Crockett HC, Delgado S, Lyman S, Madsen M, Sculco TP (2004) Mini-incision for total hip arthroplasty: a prospective, controlled investigation with 5-year follow-up evaluation. J Arthroplasty 19:538–545

    Article  PubMed  Google Scholar 

  50. Yan ZQ, Chen YS, Yang Y, Li WJ, Chen ZR, Zhang GJ (2005) Two-incision minimal invasive approach for total hip replacement. Fudan Univ J Med Sci 32:557–560

    Google Scholar 

  51. Zhang XL, He YH, Wang Q, Jiang Y, Sui SP, Zeng BF (2004) Minimally invasive incision in total hip arthroplasty for displaced femoral neck fractures in the elderly. Chin J Orthop Trauma 6:506–508

    Google Scholar 

  52. Zhang XL, Wang Q, Jiang Y, Zeng BF (2006) Minimally invasive total hip arthroplasty with anterior incision. Zhonghua Wai Ke Za Zhi 44:512–515

    PubMed  Google Scholar 

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Acknowledgments

We thank for Dr. L.D. Dorr, P. Vavken and Y.S. Chen, MD for providing additional information regarding their studies.

Conflict of interest statement

Each author certifies that he or she has no commercial associations that might pose a conflict of interest in connection with the submitted article.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Shanghai Sixth People’s Hospital, Medical College, Shanghai Jiaotong University, Shanghai, China

    T. Cheng & X. L. Zhang

  2. Department of Neurosurgery, The First Affiliated Hospital, Medical College, Nanchang University, Jiangxi, China

    J. G. Feng

  3. Department of Orthopaedic Surgery, The First Affiliated Hospital, Medical College, Soochow University, Suzhou, China

    T. Liu

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  1. T. Cheng
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  2. J. G. Feng
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  3. T. Liu
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  4. X. L. Zhang
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Corresponding author

Correspondence to X. L. Zhang.

Additional information

Tao Cheng, Jiu Geng Feng and Tao Liu all contributed equally to this work.

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Cheng, T., Feng, J.G., Liu, T. et al. Minimally invasive total hip arthroplasty: a systematic review. International Orthopaedics (SICOT) 33, 1473–1481 (2009). https://doi.org/10.1007/s00264-009-0743-z

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  • DOI: https://doi.org/10.1007/s00264-009-0743-z

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