Mini-Incision versus Standard Incision Total Hip Arthroplasty Regarding Surgical Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

PurposeIt remains controversial whether mini-incision (MI) benefits patients in total hip arthroplasty (THA). We performed a meta-analysis of randomized controlled trials (RCTs) to assess the effects of MI on surgical and functional outcomes in THA patients.MethodsA systematic electronic literature search (up to May 2013) was conducted to identify RCTs comparing MI with standard incision (SI) THA. The primary outcome measures were surgical and functional outcomes. According to the surgical approach taken, MI THA patients were divided into four subgroups for sub-group meta-analysis. Standardized mean differences (SMDs) or risk differences (RDs) with accompanying 95% confidence intervals (CIs) were calculated and pooled using a fixed-effect or random-effect model according to the heterogeneity.ResultsA total of 14 RCTs involving THA 1,174 patients met the inclusion criteria. The trials were medium risk of bias. The overall meta-analysis showed MI THA reduced total blood loss (95% CI, -201.83 to -21.18; p=.02) and length of hospital stay ( 95% CI, -0.67 to -0.08; p=.01) with significant heterogeneity. However, subgroup meta-analysis revealed posterior MI THA had perioperative advantages of reduced surgical duration ( 95% CI, -8.45 to -2.67; P<.001), less blood loss ( 95% CI, -107.20 to -1.73; P=.04) and shorter hospital stay ( 95% CI, -0.74 to -0.06; p=.002) with low heterogeneity. There were no significant differences between MI and SI THA groups in term of pain medication dose, functional outcome (HHS), radiological outcome or complications (P>.05, respectively).ConclusionsAlthough no definite overall conclusion can be arrived at on whether MI THA is superior to SI THA, posterior MI THA clearly result in a significant decrease in surgical duration, blood loss and hospital stay. It seems to be a safe minimally invasive surgical procedure without increasing the risk of component malposition or complications.

Blood loss and transfusion rate in short stem hip arthroplasty. A comparative study

“…In a study by Chang-peng et al [34], the authors showed that compared to standard incision in THA, there is some evidence that mini-incision reduces blood loss. However, there is no clear definition of Bminimally invasive,^and most would agree that soft tissue trauma is determined, not by length of incision but mainly by trauma to muscle tissue.…”

Propionibacterium avidum as an Etiological Agent of Prosthetic Hip Joint Infection

“…The main advantage of anteriorly based approaches is that they are tissue sparring by avoiding cutting major muscles and reduces the dislocation rate [ 27 – 31 ]. Surgery with mini-incision technique is thought to reduce the tissue damage even more and promote faster recovery [ 32 , 33 ].…”

Eponymous hip joint approaches

“…The assumptions, but also the controversies, with regard to outcome of these procedures are similar in all minimally invasive procedures. In meta-analysis no significant benefits (focused on blood loss, recovery and analgesia consumption) of these minimally invasive techniques were proven [40][41][42][43]. The outcomes of minimally invasive surgery can be excellent but are not necessarily superior to the standard techniques.…”