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International Orthopaedics

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01-07-2019 | Review Article

Total hip arthroplasty: minimally invasive surgery or not? Meta-analysis of clinical trials

Authors: Filippo Migliorini, Massimiliano Biagini, Björn Rath, Nadine Meisen, Markus Tingart, Jörg Eschweiler

Published in: International Orthopaedics | Issue 7/2019

Abstract

Background

There exist a relevant number of clinical trials comparing the minimally invasive surgery to the standard-invasive approach in total hip arthroplasty (THA). Up to date, there are still debates concerning the most effective approach in THA.

Aim

The purpose of this study is to compare the clinical outcomes concerning patients undergoing primary THA performed via the minimally invasive versus standard-invasive surgery incision.

Material and methods

The search was performed in the main databases, evaluating both quantitative and qualitative results. All the randomised controlled trials (RCTs) and non-randomised controlled trials (nRCTs) comparing the minimally invasive versus the standard-invasive approach were enrolled in this study. We focused on the clinical and radiological outcomes and on the complication rate. Study methodological quality was assessed performing the PEDro critical appraisal scale. All meta-analyses were performed using the Review Manager software. To analyse the publication’s bias, we performed the Funnel plot.

Result

We enrolled in our study 4761 patients, undergoing to 4842 total hip arthroplasties. The mean follow-up was 22.26 months. In favour of the minimally invasive group, we reported less total estimated blood loss, shorter surgical duration, and a shorter length of stay. In favour of the standard-invasive group, we reported a higher value of the Harris hip score. Concerning the radiological outcomes, we did not report substantial differences across the two exposures. No difference was observed regarding the risk of femoral fractures, dislocation, and revision rates. We evidenced an increasing risk occurred in an iatrogenic nerve palsy during the minimally invasive approach.

Conclusion

Based on currently available evidences concerning the outcomes following THA and the analysis of our results, we stated no remarkable benefits of the minimally invasive compared to the standard-invasive surgery.

Ulucay C, Ozler T, Guven M, Akman B, Kocadal AO, Altintas F (2013) Etiology of coxarthrosis in patients with total hip replacement. Acta Orthop Traumatol Turc 47(5):330–333CrossRefPubMed

Higgins BT, Barlow DR, Heagerty NE, Lin TJ (2015) Anterior vs. posterior approach for total hip arthroplasty, a systematic review and meta-analysis. J Arthroplast 30(3):419–434. https://doi.org/10.1016/j.arth.2014.10.020 CrossRef

Restrepo CPJ, Pour AE et al (2010) Prospective randomized study of two surgical approaches for total hip arthroplasty. J Arthroplast 25:671CrossRef

van Oldenrijk J, Scholtes VAB, van Beers L, Geerdink CH, Niers B, Runne W, Bhandari M, Poolman RW, Ctr c (2017) Better early functional outcome after short stem total hip arthroplasty? A prospective blinded randomised controlled multicentre trial comparing the Collum Femoris Preserving stem with a Zweymuller straight cementless stem total hip replacement for the treatment of primary osteoarthritis of the hip. BMJ Open 7(10):e014522. https://doi.org/10.1136/bmjopen-2016-014522 CrossRefPubMedPubMedCentral

Higgins JPT, Green S (2011) Cochrane handbook for systematic reviews of interventions Version 5.1.0. The Cochrane Collaboration. Available on www.handbook.cochrane.org Accessed on March 2018

OCEBM Levels of Evidence Working Group (2011) The Oxford 2011 levels of evidence. Oxford Centre for Evidence-Based Medicine. Available on https://www.cebm.net/2016/05/ocebm-levels-of-evidence/ Accessed on March 2018

Petis S, Howard JL, Lanting BL, Vasarhelyi EM (2015) Surgical approach in primary total hip arthroplasty: anatomy, technique and clinical outcomes. Can J Surg 58(2):128–139CrossRefPubMedPubMedCentral

Pagnano MW, Trousdale RT, Meneghini RM, Hanssen AD (2009) Slower recovery after two-incision than mini-posterior-incision total hip arthroplasty. Surgical technique. J Bone Joint Surg Am 91(Suppl 2 Pt 1):50–73. https://doi.org/10.2106/JBJS.H.01531 CrossRefPubMed

Maher CGSC, Herbert RD, Moseley AM, Elkins M (2003) Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther 83:713–721PubMed

10.

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(2):173–184. https://doi.org/10.1007/s00264-010-1075-8 CrossRefPubMed

11.

Berstock JR, Blom AW, Beswick AD (2014) A systematic review and meta-analysis of the standard versus mini-incision posterior approach to total hip arthroplasty. J Arthroplast 29(10):1970–1982. https://doi.org/10.1016/j.arth.2014.05.021 CrossRef

12.

Armijo-Olivo S, da Costa BR, Cummings GG, Ha C, Fuentes J, Saltaji H, Egger M (2015) PEDro or Cochrane to assess the quality of clinical trials? A meta-epidemiological study. PLoS One 10(7):e0132634. https://doi.org/10.1371/journal.pone.0132634 CrossRefPubMedPubMedCentral

13.

Abdel MP, Chalmers BP, Trousdale RT, Hanssen AD, Pagnano MW (2017) Randomized clinical trial of 2-incision vs mini-posterior total hip arthroplasty: differences persist at 10 years. J Arthroplast 32(9):2744–2747. https://doi.org/10.1016/j.arth.2017.04.005 CrossRef

14.

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 Arthroplast 22(4):490–495. https://doi.org/10.1016/j.arth.2006.02.173 CrossRef

15.

Biau DJ, Porcher R, Roren A, Babinet A, Rosencher N, Chevret S, Poiraudeau S, Anract P (2015) Neither pre-operative education or a minimally invasive procedure have any influence on the recovery time after total hip replacement. Int Orthop 39(8):1475–1481. https://doi.org/10.1007/s00264-015-2802-y CrossRefPubMed

16.

Chen DW, Hu CC, Chang YH, Yang WE, Lee MS (2009) Comparison of clinical outcome in primary total hip arthroplasty by conventional anterolateral transgluteal or 2-incision approach. J Arthroplast 24(4):528–532. https://doi.org/10.1016/j.arth.2008.03.016 CrossRef

17.

Chimento GF, Pavone V, Sharrock N, Kahn B, Cahill J, Sculco TP (2005) Minimally invasive total hip arthroplasty: a prospective randomized study. J Arthroplast 20(2):139–144CrossRef

18.

Chung WK, Liu D, Foo LS (2004) Mini-incision total hip replacement--surgical technique and early results. J Orthop Surg (Hong Kong) 12(1):19–24. https://doi.org/10.1177/230949900401200105 CrossRef

19.

Della Valle CJ, Dittle E, Moric M, Sporer SM, Buvanendran A (2010) A prospective randomized trial of mini-incision posterior and two-incision total hip arthroplasty. Clin Orthop Relat Res 468(12):3348–3354. https://doi.org/10.1007/s11999-010-1491-5 CrossRefPubMedPubMedCentral

20.

Dienstknecht T, Luring C, Tingart M, Grifka J, Sendtner E (2014) Total hip arthroplasty through the mini-incision (micro-hip) approach versus the standard transgluteal (Bauer) approach: a prospective, randomised study. J Orthop Surg (Hong Kong) 22(2):168–172. https://doi.org/10.1177/230949901402200210 CrossRef

21.

DiGioia AM 3rd, Plakseychuk AY, Levison TJ, Jaramaz B (2003) Mini-incision technique for total hip arthroplasty with navigation. J Arthroplast 18(2):123–128. https://doi.org/10.1054/arth.2003.50025 CrossRef

22.

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(6):1153–1160. https://doi.org/10.2106/JBJS.F.00940 CrossRefPubMed

23.

Dutka J, Sosin P, Libura M, Skowronek P (2007) Total hip arthroplasty through a minimally invasive lateral approach--our experience and early results. Ortop Traumatol Rehabil 9(1):39–45PubMed

24.

Farr D, Conn K, Britton J, Calder J, Stranks G (2009) Single incision posterior approach minimally invasive total hip arthroplasty is a safe, effective and reporducable technique in a district general hospital. A randomized controlled trial. J Bone Joint Surg Br 91(Supp III):405

25.

Fink B, Mittelstaedt A, Schulz MS, Sebena P, Singer J (2010) Comparison of a minimally invasive posterior approach and the standard posterior approach for total hip arthroplasty. A prospective and comparative study. J Orthop Surg Res 5:46. https://doi.org/10.1186/1749-799X-5-46 CrossRefPubMedPubMedCentral

26.

Goosen JH, Kollen BJ, Castelein RM, Kuipers BM, Verheyen CC (2011) Minimally invasive versus classic procedures in total hip arthroplasty: a double-blind randomized controlled trial. Clin Orthop Relat Res 469(1):200–208. https://doi.org/10.1007/s11999-010-1331-7 CrossRefPubMed

27.

Hart R, Stipcak V, Janecek M, Visna P (2005) Component position following total hip arthroplasty through a miniinvasive posterolateral approach. Acta Orthop Belg 71(1):60–64PubMed

28.

Howell JR, Masri BA, Duncan CP (2004) Minimally invasive versus standard incision anterolateral hip replacement: a comparative study. Orthop Clin North Am 35(2):153–162. https://doi.org/10.1016/S0030-5898(03)00137-8 CrossRefPubMed

29.

Khan RJMD, Hofmann M, Haebich S (2012) A comparison of a less invasive piriformis-sparing approach versus the standard posterior approach to the hip: a randomised controlled trial. J Bone J Surg Br 94(1):43–50CrossRef

30.

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 Arthroplast 21(8):1092–1098. https://doi.org/10.1016/j.arth.2006.01.015 CrossRef

31.

Kiyama TNM, 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(7):1045–1049CrossRef

32.

Krych AJ, Pagnano MW, Wood KC, Meneghini RM, Kaufmann K (2010) No benefit of the two-incision THA over mini-posterior THA: a pilot study of strength and gait. Clin Orthop Relat Res 468(2):565–570. https://doi.org/10.1007/s11999-009-0780-3 CrossRefPubMed

33.

Kubeš JLI, Podškubka A, Majernícek M, Vcelák J (2009) Total hip replacement from a MIS-AL approach (comparison with a standard anterolateral approach). Acta Chir Orthop Traumatol Cechoslov 76:288–294

34.

Laffosse JM, Chiron P, Tricoire JL, Giordano G, Molinier F, Puget J (2007) Prospective and comparative study of minimally invasive posterior approach versus standard posterior approach in total hip replacement. Rev Chir Orthop Reparatrice Appar Mot 93(3):228–237CrossRefPubMed

35.

Lawlor M, Humphreys P, Morrow E, Ogonda L, Bennett D, Elliott D, Beverland D (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(5):465–474. https://doi.org/10.1191/0269215505cr890oa CrossRefPubMed

36.

Leuchte SLA, Wohlrad D (2007) Measurement of ground reaction forces after total hip arthroplasty using different surgical approaches. Z Orthop 145:74–80CrossRefPubMed

37.

Ilchmann T, Gersbach S, Zwicky L, Clauss M (2013) Standard transgluteal versus minimal invasive anterior approach in hip arthroplasty: a prospective, consecutive cohort study. Orthop Rev (Pavia) 5(4):e31. https://doi.org/10.4081/or.2013.e31 CrossRef

38.

Martin R, Clayson PE, Troussel S, Fraser BP, Docquier PL (2011) Anterolateral minimally invasive total hip arthroplasty: a prospective randomized controlled study with a follow-up of 1 year. J Arthroplast 26(8):1362–1372. https://doi.org/10.1016/j.arth.2010.11.016 CrossRef

39.

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(12):1633–1639. https://doi.org/10.1007/s00402-009-0870-4 CrossRefPubMed

40.

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 early postoperative outcomes. A prospective, randomized, controlled trial. J Bone Joint Surg Am 87(4):701–710. https://doi.org/10.2106/JBJS.D.02645 CrossRefPubMed

41.

Pflüger GJ-JS, Schöll V (2007) Minimally invasive total hip replacement via the anterolateral approach in the supine position. Int Orthop 31(Suppl1):S7–S11CrossRefPubMed

42.

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(2):328–337. https://doi.org/10.2106/JBJS.H.01086 CrossRefPubMed

43.

Pour AE, Parvizi J, Sharkey PF, Hozack WJ, Rothman RH (2007) Minimally invasive hip arthroplasty: what role does patient preconditioning play? J Bone Joint Surg Am 89(9):1920–1927. https://doi.org/10.2106/JBJS.F.01153 CrossRefPubMed

44.

Rittmeister M, Peters A (2006) Comparison of total hip arthroplasty via a posterior mini-incision versus a classic anterolateral approach. Orthopade 35(7):716, 718–716, 722. https://doi.org/10.1007/s00132-006-0963-5 CrossRef

45.

Roy L, Laflamme GY, Carrier M, Kim PR, Leduc S (2010) A randomised clinical trial comparing minimally invasive surgery to conventional approach for endoprosthesis in elderly patients with hip fractures. Injury 41(4):365–369. https://doi.org/10.1016/j.injury.2009.10.002 CrossRefPubMed

46.

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. https://doi.org/10.1016/S0030-5898(03)00116-0 CrossRefPubMed

47.

Sershon RA, Tetreault MW, Della Valle CJ (2017) A prospective randomized trial of mini-incision posterior and 2-incision total hip arthroplasty: minimum 5-year follow-up. J Arthroplast 32(8):2462–2465. https://doi.org/10.1016/j.arth.2017.03.038 CrossRef

48.

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(6):1543–1547. https://doi.org/10.1007/s00264-008-0708-7 CrossRefPubMedPubMedCentral

49.

Speranza A, Iorio R, Ferretti M, D'Arrigo C, Ferretti A (2007) A lateral minimal-incision technique in total hip replacement: a prospective, randomizes, controlled trial. Hip Int 17(1):4–8PubMed

50.

Szendroi M, Sztrinkai G, Vass R, Kiss J (2006) The impact of minimally invasive total hip arthroplasty on the standard procedure. Int Orthop 30(3):167–171. https://doi.org/10.1007/s00264-005-0049-8 CrossRefPubMedPubMedCentral

51.

Taunton MJ, Mason JB, Odum SM, Springer BD (2014) Direct anterior total hip arthroplasty yields more rapid voluntary cessation of all walking aids: a prospective, randomized clinical trial. J Arthroplast 29(9 Suppl):169–172. https://doi.org/10.1016/j.arth.2014.03.051 CrossRef

52.

Varela Egocheaga JR, Suarez-Suarez MA, Fernandez-Villan M, Gonzalez-Sastre V, Varela-Gomez J, Murcia-Mazon A (2010) Minimally invasive posterior approach in total hip arthroplasty. Prospective randomised trial. An Sist Sanit Navar 33(2):133–143CrossRefPubMed

53.

Varela-Egocheaga JR, Suarez-Suarez MA, Fernandez-Villan M, Gonzalez-Sastre V, Varela-Gomez JR, Murcia-Mazon A (2013) Minimally invasive hip surgery: the approach did not make the difference. Eur J Orthop Surg Traumatol 23(1):47–52. https://doi.org/10.1007/s00590-011-0917-4 CrossRefPubMed

54.

Vicente JR, Croci AT, Camargo OP (2008) Blood loss in the minimally invasive posterior approach to total hip arthroplasty: a comparative study. Clinics (Sao Paulo) 63(3):351–356CrossRef

55.

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(6):685–690. https://doi.org/10.1055/s-2004-832447 CrossRefPubMed

56.

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 Arthroplast 19(5):538–545CrossRef

57.

Yang CZQ, Han Y et al (2009) Minimally-invasive total hip arthroplasty will improve early postoperative outcomes: a prospective, randomized controlled trial. Ir J Med Sci 179(2):285–289CrossRefPubMed

58.

Zawadsky MW, Paulus MC, Murray PJ, Johansen MA (2014) Early outcome comparison between the direct anterior approach and the mini-incision posterior approach for primary total hip arthroplasty: 150 consecutive cases. J Arthroplast 29(6):1256–1260. https://doi.org/10.1016/j.arth.2013.11.013 CrossRef

59.

Zhang XL, Wang Q, Jiang Y, Zeng BF (2006) Minimally invasive total hip arthroplasty with anterior incision. Zhonghua Wai Ke Za Zhi 44(8):512–515PubMed

60.

Capuano N, Grillo G, Carbone F, Del Buono A (2018) Total hip arthroplasty performed with a tissue-preserving technique using superior capsulotomy. Int Orthop 42(2):281–287. https://doi.org/10.1007/s00264-017-3722-9 CrossRefPubMed

61.

de Jong L, Klem T, Kuijper TM, Roukema GR (2018) The minimally invasive anterolateral approach versus the traditional anterolateral approach (Watson-Jones) for hip hemiarthroplasty after a femoral neck fracture: an analysis of clinical outcomes. Int Orthop 42(8):1943–1948. https://doi.org/10.1007/s00264-017-3756-z CrossRefPubMed

62.

Paraskevopoulos A, Marenghi P, Alesci M, Pogliacomi F (2014) Mini-invasive anterior approach in total hip arthroplasty: short-term follow-up. Acta Biomed 85(Suppl 2):75–80PubMed

63.

Yu YX, Yi CQ, Ma JZ, Wang QG (2016) Comparison of the effect of total hip arthroplasty through mini invasive direct anterior approach during learning curve period and posterolateral approach for the treatment of femoral head necrosis. Zhongguo Gu Shang 29(8):702–707. https://doi.org/10.3969/j.issn.1003-0034.2016.08.006 CrossRefPubMed

64.

Paillard P (2007) Hip replacement by a minimal anterior approach. Int Orthop 31(Suppl 1):S13–S15. https://doi.org/10.1007/s00264-007-0433-7 CrossRefPubMed

65.

Kawarai Y, Iida S, Nakamura J, Shinada Y, Suzuki C, Ohtori S (2017) Does the surgical approach influence the implant alignment in total hip arthroplasty? Comparative study between the direct anterior and the anterolateral approaches in the supine position. Int Orthop 41(12):2487–2493. https://doi.org/10.1007/s00264-017-3521-3 CrossRefPubMed

66.

von Rottkay E, Rackwitz L, Rudert M, Noth U, Reichert JC (2018) Function and activity after minimally invasive total hip arthroplasty compared to a healthy population. Int Orthop 42(2):297–302. https://doi.org/10.1007/s00264-017-3541-z CrossRef

67.

Woerner M, Sendtner E, Springorum R, Craiovan B, Worlicek M, Renkawitz T, Grifka J, Weber M (2016) Visual intraoperative estimation of cup and stem position is not reliable in minimally invasive hip arthroplasty. Acta Orthop 87(3):225–230. https://doi.org/10.3109/17453674.2015.1137182 CrossRefPubMedPubMedCentral

68.

Apaydin N, Kendir S, Loukas M, Tubbs RS, Bozkurt M (2013) Surgical anatomy of the superior gluteal nerve and landmarks for its localization during minimally invasive approaches to the hip. Clin Anat 26(5):614–620. https://doi.org/10.1002/ca.22057 CrossRefPubMed

69.

Martz P, Bourredjem A, Laroche D, Arcens M, Labattut L, Binquet C, Maillefert JF, Baulot E, Ornetti P (2017) Rottinger approach with dual-mobility cup to improve functional recovery in hip osteoarthritis patients: biomechanical and clinical follow-up. Int Orthop 41(3):461–467. https://doi.org/10.1007/s00264-016-3245-9 CrossRefPubMed

70.

Sariali E, Catonne Y, Pascal-Moussellard H (2017) Three-dimensional planning-guided total hip arthroplasty through a minimally invasive direct anterior approach. Clinical outcomes at five years’ follow-up. Int Orthop 41(4):699–705. https://doi.org/10.1007/s00264-016-3242-z CrossRefPubMed

Title: Total hip arthroplasty: minimally invasive surgery or not? Meta-analysis of clinical trials
Authors: Filippo Migliorini
Massimiliano Biagini
Björn Rath
Nadine Meisen
Markus Tingart
Jörg Eschweiler
Publication date: 01-07-2019
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 7/2019
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-018-4124-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Total hip arthroplasty: minimally invasive surgery or not? Meta-analysis of clinical trials

Abstract

Background

Aim

Material and methods

Result

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Aim

Material and methods

Result

Conclusion

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