Conventional versus minimally invasive total hip replacement through the posterior approach

Citation:
TarekAsaad, A. Elbadry, K. H. Salem, and K. F. M. Abdel Kader, "Conventional versus minimally invasive total hip replacement through the posterior approach", Journal of Arthroscopy and Joint Surgery, vol. 7, no. 1, pp. 26-30, 2020.

Abstract:

The rationale for minimally invasive surgery (MIS) is to minimize tissue damage in order to reduce blood loss, decrease postoperative pain, shorten hospital stay, and allow for faster rehabilitation. Objectives This study compares the short-term clinical and radiographic outcome between conventional and minimally invasive posterior approaches in total hip arthroplasty. Study Design & Methods We conducted a prospective, comparative pilot study containing 30 patients who underwent primary total hip arthroplasty between January 2017 and May 2017, 15 of them were operated through a conventional posterior approach and the other 15 were operated upon using a minimally invasive posterior approach. The exclusion criteria were severe protrusio or acetabular dysplasia as well as severe obesity (more than 120 kg body weight or a body mass index (BMI) > 40). For all patients, age, gender, indication, body mass index (BMI), preoperative hemoglobin and preoperative assessment using radiology, WOMAC and Harris hip scores were recorded. The patients were informed about the type of their operation. Results:There was a significant difference in the mean operative time (p < 0.001),rehabilitation and early return to workand usual activities (p < 0.001) in favour of the minimally invasive approach. Furthermore, there was no need for blood transfusion in the MIS group compared to 20% in the conventional group, better cosmetic results in the MIS group (mean scar length was 9.07 compared to 21.67 in the conventional approach) and more incidence of complications with the conventional approach (13.33% as compared to 0% in the MIS group). These differences were statistically highly significant (p < 0.0001). No significant differences were seen as regards the clinical outcome at 6 months post-operative (using the WOMAC and Harris hip scores) and the radiological results between in both groups. Conclusions:The minimally invasive posterior approach allows reduced blood loss, reduced operative time, decreased incidence of blood transfusion, faster rehabilitation and earlier return to workin total hip arthroplasty.

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