The Experince with Anterior Minimally Invasive Hip Surgery (original) (raw)
Related papers
The Science of Minimally Invasive Total Hip Arthroplasty
Clinical Orthopaedics and Related Research, 2007
Minimally invasive hip surgery has stimulated a new process in hip arthroplasty. There is consensus among surgeons about the benefits of anesthesia, pain management, and rapid recovery protocols. The benefits of the surgical technique for small incision surgery remain controversial. Some patients influence this controversy because they prefer minimally invasive hip surgery: they associate less body violation and better cosmesis with smaller incisions. Small incision surgery is associated with a learning curve and requires specialized instruments for favorable outcomes. Despite being a more difficult operation to perform, in skilled hands it is a safe procedure that does not increase complication rates as shown by recent prospective, randomized studies. Correct component positioning has been achieved consistently with these procedures and short-term results of small incision surgery are the same as with long incisions. New anesthesia and pain management techniques have led to remarkable early functional results, making same-day surgery possible. With improved instrumentation such as computer navigation, minimally invasive total hip arthroplasty will become more prevalent. Level of Evidence: Level V, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. From the Arthritis Institute, Inglewood, CA. Each author certifies that he has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Minimally invasive total hip arthroplasty: a systematic review
International Orthopaedics, 2009
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. 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.
Clinical Orthopaedics and Related Research®, 2011
Background For total hip arthroplasty (THA), minimally invasive surgery (MIS) uses a smaller incision and less muscle dissection than the classic approach (CLASS), and may lead to faster rehabilitation. Questions/purposes Does minimally invasive hip arthroplasty result in superior clinical outcomes? Patients and Methods In this double-blind randomized controlled trial, 120 consecutive primary noncemented THAs in 120 patients were assigned to one of two groups (MIS or CLASS). The randomization sequence was stratified for two groups of surgeons, ie, those using a posterolateral approach (PL-CLASS or PL-MIS) and those using an anterolateral approach (AL-CLASS or AL-MIS). Length of the incisions was 18 cm for the CLASS procedures. MIS incisions were extended at the skin level to 18 cm at the end of the procedure. The primary end point was the Harris hip score (HHS) at 6 weeks postoperatively. Patient-centered questionnaires were obtained preoperatively and after 6 weeks and 1 year. Results For the patients in the MIS group (average 7.8 cm incision length), statistically significant increased mean HHSs were seen compared with the CLASS group at 6 weeks and 1 year. This difference was small and mainly caused by the favorable results of the PL-MIS. In the MIS group, surgical time was longer. A learning curve was observed based on operation time and complication rate. Although not statistically significant, the perioperative complication rate was rather high in the (anterolateral) MIS group. Conclusions The minimal invasive approach in THA did not show a clinically relevant superior outcome in the first postoperative year. Level of Evidence Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Archives of Orthopaedic and Trauma Surgery, 2006
Introduction: Minimally invasive surgery represents one of the most recent techniques to have emerged within THA. In conventional THA, the incision typically measures 15-20 cm. Minimal invasive approach defined as less invasive to the skin, muscles, or bone may reduce complications and improve recovery time. A number of different approaches and methods have been described in literature. Purpose: This is a prospective study describing the technique and early results of the modified antero-lateral minimal invasive (ALMI) approach and comparing our results to the results of other investigators interested in minimal invasive THA. Materials and methods: Seventy-five consecutive primary total hip arthroplasties (cemented and cementless) were done through a modified ALMI approach (6-8 cm), in which we kept the hip abductors intact. Neither special instruments nor specially designed prostheses were needed. Minimum follow-up was 12 months. Results: The mean Harris hip score for patients after 12-month follow-up was 90 while the mean Merle d'Abugine mean score was 16.5. Both scores reached almost the maximum values within 3 months after surgery. The cup abduction angle for 70% patients was between 35°and 45°. No femoral stem mal-alignment was recorded. The mean operative time of cemented prosthesis was 65 min while that of the cementless prosthesis was 55 min. No wound complications or dislocations were recorded. All the patients were allowed to weight bear in the second post-operative day and involved in an early rehabilitation program. Conclusion: ALMI hip approach with sparing of hip abductors is safe and gives excellent orientation for positioning of prosthesis components. It also allows early and smooth post-operative rehabilitation with fast recovery of the patient in terms of weight bearing.
Primary Total Hip Arthroplasty with a Minimally Invasive Anterior Approach
Seminars in Arthroplasty, 2005
Total hip arthroplasty (THA) through the anterior approach is a minimally invasive technique that allows component implantation without muscle detachment from bone. The anterior approach is advantageous because the hip is an anterior joint, closer to the skin anterior than posterior; the approach follows an internervous plane between the superior and inferior gluteal nerves laterally and the femoral nerve medially; and the approach involves no muscle detachment. The anterior approach described here provides good access to the acetabulum and femur through the same incision, preservation of the hip muscular attachments, improved control of acetabular cup position and leg lengths, and no hip dislocation precautions postoperatively. Semin Arthro 16: [186][187][188][189][190]
Early clinical and radiographic results of minimally invasive anterior approach hip arthroplasty
Advances in orthopedics, 2014
We present a retrospective review of the early results and complications in a series of 35 consecutive patients with 43 total hip arthroplasties performed through an anterior muscle sparing minimally invasive approach. We found the early complication rates and radiographic outcomes comparable to those reported from arthroplasties performed via traditional approaches. Complications included dislocation (2%), femur fracture (2%), greater trochanteric fracture (12%), postoperative periprosthetic intertrochanteric fracture (2%), femoral nerve palsy (5%), hematoma (2%), and postoperative iliopsoas avulsion (2%). Radiographic analysis revealed average cup anteversion of 19.6° ± 6.6, average cup abduction angle of 48.4° ± 7, stem varus of 0.9° ± 2, and a mean leg length discrepancy of 0.7 mm. The anterior approach to the hip is an attractive alternative to the more traditional approaches. Acceptable component placement with comparable complication rates is possible using a muscle sparing t...
Minimally invasive hip arthroplasty: a quantitative review of the literature
British Medical Bulletin, 2007
Purpose: To perform a comprehensive quantitative review of the published literature and to assess the methodology of studies comparing the surgical outcomes in minimally invasive hip arthroplasty (MIHA). Methods: We conducted a comprehensive literature search using Medline, Embase, Cochrane, CINAHL and Google Scholar. The bibliographies of papers were also examined. All relevant articles in peer-reviewed journals were retrieved except those not mentioning outcomes, case reports, review of literature and letters to editors. Two authors independently scored the quality of the studies using a modified Coleman Methodology Score with 10 criteria which allow critical analysis of the design and implementation of a particular study. The results are recorded as a final score between 0 and 100. We collected data for year of publication, type of study, patient numbers, surgical method, followup, complications and patient satisfaction. Results: Thirty-six studies met our inclusion criteria giving details of 6434 HAs, 78.5% (4031) of which were implanted using MIHA techniques. The only statistically significant outcome was a reduction in length of hospital stay (P ¼ 0.02). With no significant difference noted between the two groups with respect to operating time, blood loss, dislocation and revision rates, neurological injury and incidence of peri-operative fracture, patient selection and surgeons' experience may have had a significant effect on outcome. For instance, studies reporting outcomes on an average patient age of 48 years had significantly different results to one reporting on patients with a mean age of over 70 years. Scores were predominantly low for quality of the studies, with patient number, follow-up time and validated outcome measures being the weakest areas. Conclusion: At present, there is still a lack of quality evidence to advocate the expansion of MIHA. The better designed studies suggest that it should even be limited further to recognized expert centres. The complication rates and learning curve may be altered by changes in training and adapting surgical techniques. We emphasize the need for meticulous design in future studies comparing the outcomes of these two procedures.
Why Minimally Invasive Surgery in Hip Arthroplasty?
Recent Advances in Hip and Knee Arthroplasty, 2012
We evaluated 199 hips (187 patients) which received reconstructive surgery in our Institution. Surgery was performed by three senior surgeons of our Hospital since May 2004 until December 2009. We selected only patients with analogous demographic data and surgeries done by these three senior physicians to homogenize results and implants. No hip fracture was www.intechopen.com
2017
Total hip arthroplasty remains the treatment of choice for the symptomatic osteoarthritis of the hip. The most common approach used is the Posterior Approach of Moore (PA), known to give good and reliable results [1,2]. Nevertheless, during the last decades the minimal invasive approaches have become more and more popular, especially the Direct Anterior Approach (DAA) by Hueter [3]. This is mainly due to studies showing the advantage of faster recovery (in the first 6 to 12 weeks) and shorter length of stay in hospital but no advantage is seen in long term results [4-8]. However, it’s a technically demanding approach particularly during the early stage of the learning curve [9,10] with occurrence of more intra-operative fractures, nervous lesions and implant malpositioning [11-13]. Beside these two frequently used approaches, the mini-invasive anterolateral approach described by Rottinger (ALA) shows good functional and radiological results [14,15].