Minimally invasive and computer-navigated total hip arthroplasty: a qualitative and systematic review of the literature

Abstract

BackgroundBoth minimally invasive surgery (MIS) and computer-assisted surgery (CAS) for total hip arthroplasty (THA) have gained popularity in recent years. We conducted a qualitative and systematic review to assess the effectiveness of MIS, CAS and computer-assisted MIS for THA.MethodsAn extensive computerised literature search of PubMed, Medline, Embase and OVIDSP was conducted. Both randomised clinical trials and controlled clinical trials on the effectiveness of MIS, CAS and computer-assisted MIS for THA were included. Methodological quality was independently assessed by two reviewers. Effect estimates were calculated and a best-evidence synthesis was performed.ResultsFour high-quality and 14 medium-quality studies with MIS THA as study contrast, and three high-quality and four medium-quality studies with CAS THA as study contrast were included. No studies with computer-assisted MIS for THA as study contrast were identified. Strong evidence was found for a decrease in operative time and intraoperative blood loss for MIS THA, with no difference in complication rates and risk for acetabular outliers. Strong evidence exists that there is no difference in physical functioning, measured either by questionnaires or by gait analysis. Moderate evidence was found for a shorter length of hospital stay after MIS THA. Conflicting evidence was found for a positive effect of MIS THA on pain in the early postoperative period, but that effect diminished after three months postoperatively. Strong evidence was found for an increase in operative time for CAS THA, and limited evidence was found for a decrease in intraoperative blood loss. Furthermore, strong evidence was found for no difference in complication rates, as well as for a significantly lower risk for acetabular outliers.ConclusionsThe results indicate that MIS THA is a safe surgical procedure, without increases in operative time, blood loss, operative complication rates and component malposition rates. However, the beneficial effect of MIS THA on functional recovery has to be proven. The results also indicate that CAS THA, though resulting in an increase in operative time, may have a positive effect on operative blood loss and operative complication rates. More importantly, the use of CAS results in better positioning of acetabular component of the prosthesis.

Ganganalyse nach minimal-invasiver Hüftprothesenimplantation

“…B. geringeren Blutverlust, schnellere Schmerzfreiheit oder die Möglichkeit einer schnelleren Rehabilitation [12,32,33]. Einen Literaturüberblick zu Studien der minimal-invasiven Hüftal-loarthroplastik geben Reininga et al [24]. Dabei wird besonders auf die Studienqualität, operative Komplikationen sowie auf geeignete Outcomeparameter eingegangen.…”

Navigation is Equal to Estimation by Eye and Palpation in Preventing Psoas Impingement in THA

“…Minimally invasive surgical techniques with reduced incision lengths and less-extensive exposures are safe without greater operative complication or component malrotation rates [16]. However, with these approaches it is more difficult for the orthopaedic surgeon to estimate the anatomic situation intraoperatively [4,25].…”

The use of computer-assisted surgery as an educational tool for the training of orthopedic surgery residents in pedicle screw placement: a pilot study and survey among orthopedic residents

“…Accordingly, the number of orthopedic surgeons using navigation techniques is also increasing. Although CAS has been found to improve surgery outcomes in patients undergoing total knee [21][22][23] or hip 24 replacements and to facilitate pedicle screw placement, 4,6-8 we are not aware of any study that evaluated the perception and effectiveness of CAS for the training of future orthopedic surgeons.…”