Comparison of Clinical Outcome in Primary Total Hip Arthroplasty by Conventional Anterolateral Transgluteal or 2-Incision Approach

Chen, Dave Wei-Chih; Hu, Chih-Chien; Chang, Yu‐Han; Yang, Wen-E; Lee, Mel S.

doi:10.1016/j.arth.2008.03.016

Cited by 28 publications

(17 citation statements)

References 25 publications

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“…When assessed individually, the risk of transient lateral femoral cutaneous nerve palsy was significantly higher following MIS (RR=16.2; p=0.006; Fig. 5); however, this finding was weighted by a high proportion of cases reported in a cohort study by Chen et al [26]. There was no statistically significant difference between the groups with respect to the incidence of sciatic nerve palsy (p=0.11; Table 5).…”

Section: Complicationscontrasting

confidence: 46%

Minimally invasive versus conventional exposure for total hip arthroplasty: a systematic review and meta-analysis of clinical and radiological outcomes

Smith

Blake

Hing

2010

International Orthopaedics (SICOT)

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Over the past decade, minimally invasive surgery has gained popularity as a means of optimising early postoperative rehabilitation and increasing patient satisfaction and cosmesis following total hip arthroplasty (THA). However, this surgical exposure has also been associated with increased risk of iatrogenic nerve injury and implant mal-positioning due to limited visibility compared to conventionally larger surgical incisions. The purpose of this meta-analysis was to compare the outcomes of these two surgical exposures. A systematic review of the published and unpublished literature was conducted to include all randomised and non-randomised controlled trials comparing the clinical and radiological outcomes of minimally invasive and conventional THA procedures. In total, 28 studies met the eligibility criteria and included 2,849 hips, i.e. 1,428 minimally invasive compared to 1,421 conventional THAs. The meta-analysis of the current evidence base showed that minimally invasive THA is associated with a significantly increased risk of transient lateral femoral cutaneous nerve palsy (p=0.006) with no significantly better outcome.

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Section: Complicationscontrasting

confidence: 46%

Minimally invasive versus conventional exposure for total hip arthroplasty: a systematic review and meta-analysis of clinical and radiological outcomes

Smith

Blake

Hing

2010

International Orthopaedics (SICOT)

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“…This might be explained by either the small patient group or by the followup time, since most beneficial effects of minimally invasive surgery are reported for the early rehabilitation period [9,24]. However, several studies suggest there are no substantial clinical benefits of minimally invasive THA [12,33,48].…”

Section: Discussionmentioning

confidence: 99%

“…Most assessments of muscle damage are based on muscle function tests (eg, gait analysis, EMG), which only allow indirect and nonspecific conclusions about muscle trauma [1,4,9,20,31,37,40,46], or on cadaver investigations in which only the traumatized muscle tissue can be evaluated and not nerve damage, compression damage, or in particular the regenerative capacity of the muscles [27,30].…”

Section: Introductionmentioning

confidence: 99%

Evidence of Reduced Muscle Trauma Through a Minimally Invasive Anterolateral Approach by Means of MRI

Müller

Tohtz

Dewey

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Minimally invasive techniques in THA are intended to minimize periarticular muscle trauma. The lateral approach has a risk of partial gluteal insufficiency, while the anterolateral approach carries the risk of damaging the tensor fasciae latae through intermuscular nerve and compression injury. Questions/purposes We assessed the surgical influence of the anterolateral minimally invasive approach and the modified direct lateral approach on the tensor fasciae latae and gluteus medius. Methods We prospectively randomized 44 patients with primary coxarthrosis to receive a cementless THA via the anterolateral minimally invasive approach or the modified direct lateral approach. We performed clinical and MRI examinations preoperatively and 3 and 12 months postoperatively, including Harris hip and pain scores. MRI analysis included assessment of the tensor fasciae latae and gluteus medius with regard to fatty atrophy and changes in the muscle cross-sectional area.Results Clinical scores were similar in the two groups but a low-grade Trendelenburg sign was observed more frequently in the lateral group. MRI showed a pronounced, postoperative fatty atrophy of the anterior part of the gluteus medius more often; and a compensatory hypertrophy of the tensor fasciae latae occurred. Higher-grade atrophy of the tensor fasciae latae and gluteus medius did not occur with the anterolateral approach. Conclusions We found no increased damage to the tensor fasciae latae with the anterolateral approach. The lateral approach was associated with increased partial gluteus atrophy and a compensatory hypertrophy of the tensor fasciae latae. Based on fewer structural changes in the musculature, we recommend the anterolateral minimally invasive approach.

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“…By combining the above surgical routes, THA can also be done by the double incision methods [1,[7][8][9][10][11] or the triple incision method [12]. The double incision method is a modified method of the direct anterior approach by Berger and Mears.…”

Section: The Combined Approachmentioning

confidence: 99%

“…One decreases the wound and muscle cutting and emphasizes the tissue repair through either a lateral or a posterior route. [1][2][3][4] The other spares muscle sectioning during the procedure through one [5,6], two [1,[7][8][9][10][11], or multiple [12] incisions. The abridged incision methods minimize the incision length and can be extensile if difficulties are encountered during THA.…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive total hip arthroplasty

Lee

2011

Formosan Journal of Musculoskeletal Disorders

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Comparison of Clinical Outcome in Primary Total Hip Arthroplasty by Conventional Anterolateral Transgluteal or 2-Incision Approach

Cited by 28 publications

References 25 publications

Minimally invasive versus conventional exposure for total hip arthroplasty: a systematic review and meta-analysis of clinical and radiological outcomes

Minimally invasive versus conventional exposure for total hip arthroplasty: a systematic review and meta-analysis of clinical and radiological outcomes

Evidence of Reduced Muscle Trauma Through a Minimally Invasive Anterolateral Approach by Means of MRI

Minimally invasive total hip arthroplasty

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