Two-incision total hip replacement: Intra-operative fluoroscopy versus imageless navigation for cup placement

Abstract

The purpose of this study was to describe the surgical technique and to investigate results of a modified two-incision total hip replacement using either intraoperative fluoroscopy or imageless navigation. Twenty-nine patients (30 hips) with a minimum follow-up of one year were enrolled in this study. The patients were evaluated at 3, 6, 12 weeks, 6 months, and 1-year. The functional recovery as represented by the Harris hip score and WOMAC scale were better in the fluoroscopy group of patients at the early postoperative stage (3 wks). Thereafter, both groups showed rapid recovery with no difference in scores. Injury to the lateral femoral cutaneous nerve was the most commonly seen complication and it occurred in 6 hips (fluoroscopy 2; imageless 4). The symptoms were transient and resolved in 6 months in all 6 cases. This study demonstrated that the role of intraoperative fluoroscopy could safely be replaced by an imageless navigation system for the MIS-2 THA.

Minimally Invasive Total Hip Arthroplasty

“…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.…”

“…Under the fluoroscopic guidance, both the acetabular and the femoral component can be implanted in predetermined position. We and others have modified the two-incision technique by putting the patient in the lateral decubitus position [9][10][11]. The anterior skin incision is made perpendicular to the long axis of the femoral neck about 3 to 4 finger-breadth distal to the ilioinguinal line.…”

“…By this modification, the process of femoral canal preparation can be safely done under direct vision without the help of the fluoroscopic monitoring. [9][10][11]19] The triple incision method is similar to the double incision method. It can be done with the patient in the supine or in the lateral decubitus position.…”

“…The single-incision techniques include the anterolateral (modified Watson-Jones) approach [5] and the direct anterior approach (Smithwww.intechopen.com Peterson) [6,21,22]. The multiple-incision techniques include the two-incision approach [7][8][9][10][11] or the three-incision approach [12]. Although the muscle sparing MIS-THA techniques are also the modification of the classic anterior or anterolateral approach to the hip joint, these techniques are greatly different from the classic ones in terms of the skin incision and tissue dissection.…”

“…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.…”