Top

Published in:

01-03-2012 | Original Paper

Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach

Authors: Sascha Goebel, Andre F. Steinert, Judith Schillinger, Jochen Eulert, Jens Broscheit, Maximilian Rudert, Ulrich Nöth

Published in: International Orthopaedics | Issue 3/2012

Abstract

Purpose

The development of minimal-incision techniques for total hip replacement with preservation of soft tissue is generally associated with faster rehabilitation, reduction of postoperative pain and increased patient comfort. The aim of this study was to compare a minimal-incision anterior approach with a transgluteal lateral technique for hip replacement surgery with respect to postoperative pain, consumption of rescue medication, length of hospital stay and time to reach a defined range of motion.

Methods

In this retrospective cohort study we investigated 100 patients with a minimal-incision anterior approach (group I) and 100 patients with a transgluteal lateral approach (group II) retrospectively undergoing unilateral hip replacement. The study variables were pain at rest and during physiotherapy, amount of rescue medication, the time to reach a defined flexion and time in hospital.

Results

The patients of group I consumed less rescue medication (19.6 ± 6.9 mg vs. 23.6 ± 11.3 mg; p = 0.005) and experienced less pain on the day of surgery (1.3 ± 1 vs. 2.3 ± 1.3, p = 0.0001) and the first postoperative day (0.41 ± 0.8 vs. 0.66 ± 1.1, p = 0.036). The time to reach the defined range of motion (6.4 ± 2 days vs. 7.4 ± 2.1 days; p = 0.001) and the length of hospital stay were shorter (10.2 ± 1.9 days vs. 13.4 ± 1.6 days; p = 0.0001) for group I. However, pain during physiotherapy was higher on the third and sixth through ninth days after surgery in comparison to group II (p = 0.001–0.013).

Conclusion

The implantation of a hip prosthesis through a minimal-incision anterior approach is successful in reducing postoperative pain and consumption of pain medication. Time to recovery and length of hospital stay are also influenced positively. Pain increases during physiotherapy, and may be mitigated by adopting limited weight bearing during the early postoperative period.

Basbaum AI (1999) Spinal mechanisms of acute and persistent pain. Reg Anesth Pain Med 24:59–67PubMed

Bennett D, Ogonda L, Elliott D, Humphreys L, Lawlor M, Beverland D (2007) Comparison of immediate postoperative walking ability in patients receiving minimally invasive and standard-incision hip arthroplasty: a prospective blinded study. J Arthroplasty 22:490–495PubMedCrossRef

Berger RA (2003) Total hip arthroplasty using the minimally invasive two-incision approach. Clin Orthop Relat Res 417:232–241

Bernasek TL, Lee WS, Lee HJ, Lee JS, Kim KH, Yang JJ (2010) Minimally invasive primary THA: anterolateral intermuscular approach versus lateral transmuscular approach. Arch Orthop Trauma Surg 130:1349–1354

Chang KY, Tsou MY, Chan KH, Sung CS, Chang WK (2006) Factors affecting patient-controlled analgesia requirements. J Formos Med Assoc 105:918–925PubMedCrossRef

Cheng T, Feng JG, Liu T, Zhang XL (2009) Minimally invasive total hip arthroplasty: a systematic review. Int Orthop 33:1473–1481PubMedCrossRef

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

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

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 89:1153–1160PubMedCrossRef

10.

Gaspar L, Dezso B, Csernatony Z, Gaspar L, Szabo J, Szekanecz Z et al (2004) Capsular neuronal elements and their relation to pain reduction and functional improvement following total hip replacement. Int Orthop 28:142–145PubMedCrossRef

11.

Kampa RJ, Prasthofer A, Lawrence-Watt DJ, Pattison RM (2007) The internervous safe zone for incision of the capsule of the hip. A cadaver study. J Bone Joint Surg Br 89:971–976PubMedCrossRef

12.

Lawlor M, Humphreys P, Morrow E, Ogonda L, Bennett D, Elliott D et al (2005) Comparison of early postoperative functional levels following total hip replacement using minimally invasive versus standard incisions. A prospective randomized blinded trial. Clin Rehabil 19:465–474PubMedCrossRef

13.

Liu S, Carpenter RL, Neal JM (1995) Epidural anesthesia and analgesia. Their role in postoperative outcome. Anesthesiology 82:1474–1506PubMedCrossRef

14.

Lux EA, Stamer U, Meissner W, Moser K, Neugebauer E, Wiebalck A (2008) Postoperative pain after ambulatory surgery. Schmerz 22:171–175PubMedCrossRef

15.

Mazoochian F, Weber P, Schramm S, Utzschneider S, Fottner A, Jansson V (2009) Minimally invasive total hip arthroplasty: a randomized controlled prospective trial. Arch Orthop Trauma Surg 129:1633–1639PubMedCrossRef

16.

Muller M, Tohtz S, Dewey M, Springer I, Perka C (2011) 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. Int Orthop 35:165–171PubMedCrossRef

17.

Murphy SB, Tannast M (2006) Conventional vs minimally invasive total hip arthroplasty. A prospective study of rehabilitation and complications. Orthopade 35(7):761–764, 766–768

18.

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

19.

Perkins FM, Kehlet H (2000) Chronic pain as an outcome of surgery. A review of predictive factors. Anesthesiology 93:1123–1133PubMedCrossRef

20.

Peters CL, Shirley B, Erickson J (2006) The effect of a new multimodal perioperative anesthetic regimen on postoperative pain, side effects, rehabilitation, and length of hospital stay after total joint arthroplasty. J Arthroplasty 21:132–138PubMedCrossRef

21.

Pospischill M, Kranzl A, Attwenger B, Knahr K (2010) Minimally invasive compared with traditional transgluteal approach for total hip arthroplasty: a comparative gait analysis. J Bone Joint Surg Am 92:328–337

22.

Rachbauer F (2006) Minimally invasive total hip arthroplasty. Anterior approach. Orthopade 35(7):723–724, 726–729PubMedCrossRef

23.

Rachbauer F, Krismer M (2008) Minimally invasive total hip arthroplasty via direct anterior approach. Oper Orthop Traumatol 20:239–251PubMedCrossRef

24.

Raja SN, Dougherty PM (2000) Reversing tissue injury-induced plastic changes in the spinal cord: the search for the magic bullet. Reg Anesth Pain Med 25:441–444PubMed

25.

Shitama T, Kiyama T, Naito M, Shiramizu K, Huang G (2009) Which is more invasive-mini versus standard incisions in total hip arthroplasty? Int Orthop 33:1543–1547PubMedCrossRef

26.

Smith TO, Blake V, Hing CB (2011) Minimally invasive versus conventional exposure for total hip arthroplasty: a systematic review and meta-analysis of clinical and radiological outcomes. Int Orthop 35:173–184PubMedCrossRef

27.

Wohlrab D, Hagel A, Hein W (2004) Advantages of minimal invasive total hip replacement in the early phase of rehabilitation. Z Orthop Ihre Grenzgeb 142:685–690PubMedCrossRef

28.

Woolson ST, Mow CS, Syquia JF, Lannin JV, Schurman DJ (2004) Comparison of primary total hip replacements performed with a standard incision or a mini-incision. J Bone Joint Surg Am 86-A:1353–1358PubMed

29.

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 19:538–545PubMedCrossRef

Title: Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach
Authors: Sascha Goebel
Andre F. Steinert
Judith Schillinger
Jochen Eulert
Jens Broscheit
Maximilian Rudert
Ulrich Nöth
Publication date: 01-03-2012
Publisher: Springer-Verlag
Published in: International Orthopaedics / Issue 3/2012
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-011-1280-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2012

Reconstruction of the patella with an autogenous iliac graft: clinical and radiologic results in thirteen patients

Femoral shortening and cementless arthroplasty in Crowe type 4 congenital dislocation of the hip

Less wear with aluminium-oxide heads than cobalt-chrome heads with ultra high molecular weight cemented polyethylene cups: A ten-year follow-up with radiostereometry

Could the use of bone morphogenetic proteins in fracture healing do more harm than good to our patients?

Reliability and predictability of the centre-edge angle in the assessment of pincer femoroacetabular impingement

Letter regarding Lerch et al.: Bone remodelling around the Metha short stem in total hip arthroplasty: a prospective dual-energy X-ray absorptiometry study