Minimally invasive hip surgery: the approach did not make the difference

Varela-Egocheaga, J.R.; Suárez-Suárez, M.A.; Fernández-Villán, M.; González-Sastre, V.; Varela-Gómez, J.R.; Murcia-Mazón, A.

doi:10.1007/s00590-011-0917-4

Cited by 11 publications

(39 citation statements)

References 19 publications

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“…The heterogeneity was moderate (I 2 = 68%). Sensitivity analyses yielded similar results after exclusion of 2 studies [ 32 , 38 ] that did not use morphine consumption as doses of pain medication (SMD, -0.09; 95% CI, -0.32 to 0.14; p=.43). Similarly, there was not a significant difference between the posterior MI and SI subgroups in morphine consumption (WMD, -0.08; 95% CI, -0.40 to 0.24; P=.61) with low heterogeneity (I 2 = 42%).…”

Section: Resultsmentioning

confidence: 75%

“…Based on analgesic consumption, our results indicated MI THA did not result in better early pain control, which was in agreement with Pour et al [ 41 ], de Beer et al [ 42 ] and Asayama et al [ 43 ]. Remarkably, one RCT [ 38 ] included in our meta-analysis of the lateral subgroup showed a significant reduction in metamizol intaking. We believe, however, this finding was not powerful because of the different analgesic regime they used and a small number of subjects in their study which likely led to type II statistical error [ 44 ].…”

Section: Discussionmentioning

confidence: 90%

“…Of the 14 studies, 3 included surgical interventions via the posterior approach [ 27 , 29 , 35 ], 5 involved the posterolateral approach [ 26 , 28 , 30 , 31 , 36 ], 3 the lateral approach [ 33 , 37 , 38 ] and 4 the anterolateral approach [ 30 , 32 , 34 , 39 ]. Among them, the study [ 30 ] by Goosen et al involved both the anterolateral and the posterior approaches.…”

Section: Resultsmentioning

confidence: 99%

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

Song

et al. 2013

PLoS ONE

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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.

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Section: Resultsmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 99%

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

Song

et al. 2013

PLoS ONE

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“…We identified 2130 potential studies from database searches, of which 63 studies 8 , 9 , 11 , 12 , 13 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 were eligible for inclusion (…”

Section: Resultsmentioning

confidence: 99%

“…A total of 45 studies 9,12,13,38,39,[41][42][43][44][47][48][49][50][52][53][54][55][56][57][58][59][60][61]63,64,[66][67][68]70,72,73,[76][77][78][79][80][81][82][83][88][89][90][91]93,94 (71%) with 3437 participants (71%) reported on operation time (Figure 3 and Figure 5). PA was associated with…”

Section: Operation Timementioning

confidence: 99%

Evaluation of Comparative Efficacy and Safety of Surgical Approaches for Total Hip Arthroplasty

Yan

Dong

et al. 2023

JAMA Netw Open

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ImportanceEach approach for primary total hip arthroplasty (THA) has a long learning curve, so a surgeon’s choice to change their preferred approach needs to be guided by clear justifications. However, current evidence does not suggest that any of the THA approaches are more beneficial than others, and the choice of approach is mainly based on the knowledge and experience of the surgeon and individual patient characteristics.ObjectiveTo assess the efficacy and safety associated with different surgical approaches for THA.Data SourcesA comprehensive search of PubMed, EMBASE, and Cochrane databases from inception to March 26, 2022; reference lists of eligible trials; and related reviews.Study SelectionRandomized clinical trials (RCTs) comparing different surgical approaches, including the 2-incision approach, direct anterior approach (DAA), direct lateral approach (DLA), minimally invasive direct lateral approach (MIS-DLA), minimally invasive anterolateral approach (MIS-ALA), posterior approach (PA), minimally invasive posterior approach (MIS-PA), and supercapsular percutaneously assisted total hip arthroplasty (SuperPath), for primary THA.Data Extraction and SynthesisFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, 2 reviewers independently extracted data on study participants, interventions, and outcomes as well as assessed the risk of bias using the Cochrane risk of bias tool and the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation framework. A frequentist framework was used to inform a series of random-effects network meta-analyses.Main Outcomes and MeasuresThe outcomes were hip score (range, 0-100, with higher scores indicating better overall hip condition), pain score (range, 0-100, with higher scores indicating more pain), hospitalization time, operation time, quality of life score, blood loss, cup abduction angle, and cup anteversion angle.ResultsOf 2130 retrieved studies, 63 RCTs including 4859 participants (median [IQR] age, 64.0 [60.3-66.5] years; median [IQR] percentage male, 46.74% [38.64%-54.74%]) were eligible for analysis. Eight surgical approaches were evaluated. For hip score, DAA (mean difference [MD], 4.04; 95% CI, 1.92 to 6.16; moderate certainty), MIS-ALA (MD, 3.00; 95% CI, 0.43 to 5.59; moderate certainty), MIS-DLA (MD, 3.37; 95% CI, 1.05 to 5.68; moderate certainty), MIS-PA (MD, 4.46; 95% CI, 1.60 to 7.31; moderate certainty), PA (MD, 4.37; 95% CI, 1.87 to 6.88; high certainty), and SuperPath (MD, 5.00; 95% CI, 0.58 to 9.42; high certainty) were associated with greater improvement in hip score compared with DLA. DLA was associated with lower decrease in pain score than SuperPath (MD, 1.16; 95% CI, 0.13 to 2.20; high certainty) and MIS-DLA (MD, 0.90; 95% CI, 0.04 to 1.76; moderate certainty). PA was associated with shorter operation times compared with 2-incision (MD, −23.85 minutes; 95% CI, −36.60 to −11.10 minutes; high certainty), DAA (MD, −13.94 minutes; 95% CI, −18.79 to −9.08 minutes; moderate certainty), DLA (MD, −10.50 minutes; 95% CI, −16.07 to −4.94 minutes; high certainty), MIS-ALA (MD, −6.76 minutes; 95% CI, −12.86 to −0.65 minutes; moderate certainty), and SuperPath (MD, −13.91 minutes; 95% CI, −21.87 to −5.95 minutes; moderate certainty). The incidence of 6 types of complications did not differ significantly between the approaches.Conclusions and RelevanceIn this study, moderate to high certainty evidence indicated that compared with PA, all surgical approaches except DLA were associated with similar improvements of hip score but longer operation time. DLA was associated with smaller improvement of hip score. The safety of the different approaches did not show significant differences. These findings will help health professionals and patients with better clinical decision-making and also provide references for policy makers.

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The Idea of “Minimally Invasive Solution” Total Hip Arthroplasty: History and Perspective Behind the Modernization of Surgery Through the Watson-Jones Muscle Interval

Röttinger

2022

The Anterior-Based Muscle-Sparing Approach to Total Hip Arthroplasty

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Minimally invasive hip surgery: the approach did not make the difference

Abstract: Our results suggested that minimally invasive lateral approach has not provided significant benefits over conventional lateral approach for the implantation of a total hip arthroplasty.

Cited by 11 publications

References 19 publications

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

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

Evaluation of Comparative Efficacy and Safety of Surgical Approaches for Total Hip Arthroplasty

The Idea of “Minimally Invasive Solution” Total Hip Arthroplasty: History and Perspective Behind the Modernization of Surgery Through the Watson-Jones Muscle Interval

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