Minimal Incision Surgery as a Risk Factor for Early Failure of Total Hip Arthroplasty
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Minimal incision total hip arthroplasty (MI THA) techniques were developed to decrease postoperative pain and recovery time. Although these techniques have increased in popularity, the long-term survivorship of these procedures is unknown.
We therefore investigated whether the time to revision in our referral practice was shorter for patients who underwent primary MI THA compared to primary traditional THA.
We retrospectively reviewed 46 revision THAs performed during a 3-year period. We excluded revisions performed for infection and rerevisions. Patients with incisions less than or equal to 10 cm were defined as having had MI THA. Fifteen of the 46 patients (33%) had undergone primary MI THA. At the time of primary index THA, the mean ages of the MI and non-MI patients were 65 years and 55 years, respectively.
The mean time to revision was 1.4 years for the MI patients compared with 14.7 years for the non-MI patients. Twelve of the 15 patients having MI THA required revision within 2 years of primary THA compared to 4 of the 31 patients without MI surgery (OR = 26.5, 95% CI 4.4–160.0). There were no differences between the groups with regard to age, gender, or body mass index. The most common reasons for revision in the MI THA group were intraoperative fracture and failure of femoral component osseointegration.
Our data suggest MI THA may be a risk factor for early revision surgery and the long-term survival therefore may be lower than that for non-MI surgery.
Level of Evidence
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
- Bal BS, Haltom D, Aleto T, Barrett M. Early complications of primary total hip replacement performed with a two-incision minimally invasive technique. J Bone Joint Surg Am. 2005;87:2432–2438. CrossRef
- Berry DJ, Berger RA, Callaghan JJ, Dorr LD, Duwelius PJ, Hartzband MA, Lieberman JR, Mears DC. Minimally invasive total hip arthroplasty. Development, early results, and a critical analysis. Presented at the Annual Meeting of the American Orthopaedic Association, Charleston, South Carolina, USA, June 14, 2003. J Bone Joint Surg Am. 2003;85:2235–2246.
- Bozic K. Single mini-incision has some perioperative advantages over standard-incision total hip replacement. J Bone Joint Surg Am. 2009;91:1279. CrossRef
- Bozic KJ, Beringer D. Economic considerations in minimally invasive total joint arthroplasty. Clin Orthop Relat Res. 2007;463:20–25.
- Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009;91:128–133. CrossRef
- Callaghan JJ, Bracha P, Liu SS, Piyaworakhun S, Goetz DD, Johnston RC. Survivorship of a Charnley total hip arthroplasty. A concise follow-up, at a minimum of thirty-five years, of previous reports. J Bone Joint Surg Am. 2009;91:2617–2621. CrossRef
- Chimento GF, Pavone V, Sharrock N, Kahn B, Cahill J, Sculco TP. Minimally invasive total hip arthroplasty. J Arthroplasty. 2005;20:139–144. CrossRef
- Crowe JF, Sculco TP, Kahn B. Revision total hip arthroplasty: hospital cost and reimbursement analysis. Clin Orthop Relat Res. 2003;413:175–182. CrossRef
- Dorr LD, Maheshwari AV, Long WT, Wan Z, Sirianni LE. Early pain relief and function after posterior minimally invasive and conventional total hip arthroplasty. A prospective, randomized, blinded study. J Bone Joint Surg Am. 2007;89:1153–1160. CrossRef
- Hungerford DS. Minimally invasive total hip arthroplasty: in opposition. J Arthroplasty. 2004;19(Suppl 1):81–82. CrossRef
- Kim YH. Comparison of primary total hip arthroplasties performed with a minimally invasive technique or a standard technique. J Arthroplasty. 2006;21:1092–1098. CrossRef
- Kurtz SM, Ong KL, Schmier J, Mowat F, Saleh K, Dybvik E, Kärrholm J, Garellick G, Havelin LI, Furnes O, Malchau H, Lau E. Future clinical and economic impact of revision total hip and knee arthroplasty. J Bone Joint Surg Am. 2007;89:144–151. CrossRef
- Lubowitz JH, Sahasrabudhe A, Appleby D. Minimally invasive surgery in total knee arthroplasty: the learning curve. Orthopedics. 2007;30:80–82.
- Masonis J, Thompson C, Odum S. Safe and accurate: learning the direct anterior total hip arthroplasty. Orthopedics. 2008;31(Suppl 2).
- Mow CS, Woolson ST, Ngarmukos SG, Park EH, Lorenz HP. Comparison of scars from total hip replacements done with a standard or mini-incision. Clin Orthop Relat Res. 2005:441:80–85. CrossRef
- Ogonda L, Wilson R, Archbold P, Lawlor M, Humphreys P, O’Brien S, Beverland D. A minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes: a prospective randomized trial. J Bone Joint Surg Am. 2005;87:701–710. CrossRef
- Pagnano MW, Hebl J, Horlocker T. Assuring a painless total hip arthroplasty: a multimodal approach emphasizing peripheral nerve blocks. J Arthroplasty. 2006;21(Suppl 1):80–84. CrossRef
- Pagnano MW, Trousdale RT, Meneghini RM, Hanssen AD. Slower recovery after two-incision than mini-posterior-incision total hip arthroplasty. A randomized clinical trial. J Bone Joint Surg Am. 2008;90:1000–1006. CrossRef
- Peters CL, Erickson JA, Hines JL. Early results of the Bernese periacetabular osteotomy: the learning curve at an academic medical center. J Bone Joint Surg Am. 2006;88:1920–1926. CrossRef
- Pour AE, Parvizi J, Sharkey PF, Hozack WJ, Rothman RH. Minimally invasive hip arthroplasty: what role does patient preconditioning play? J Bone Joint Surg Am. 2007;89:1920–1927. CrossRef
- Sculco TP. Minimally invasive total hip: in the affirmative. J Arthroplasty. 2004;19(Suppl 1):78–80. CrossRef
- Seng BE, Berend KR, Ajluni AF, Lombardi AV Jr. Anterior-supine minimally invasive total hip arthroplasty: defining the learning curve. Orthop Clin North Am. 2009;40:343–350. CrossRef
- Wall SJ, Mears SC. Analysis of published evidence on minimally invasive total hip arthroplasty. J Arthroplasty. 2008;23(Suppl 7):55–58. CrossRef
- Woolson ST, Mow CS, Syquia JF, Lannin JV, Schurman DJ. Comparison of primary total hip replacements performed with a standard or a mini-incision. J Bone Joint Surg Am. 2004;86:1353–1358.
- Woolson ST, Pouliot MA, Huddleston JI. Primary total hip arthroplasty using an anterior approach and a fracture table. J Arthroplasty. 2009;24:999–1005. CrossRef
- Wright JM, Crockett HC, Delgado S, Lyman S, Madsen M, Sculco TP. Mini-incision for total hip arthroplasty: a prospective, controlled investigation with 5-year follow-up evaluation. J Arthroplasty. 2004;19:538–545. CrossRef
- Minimal Incision Surgery as a Risk Factor for Early Failure of Total Hip Arthroplasty
Clinical Orthopaedics and Related Research®
Volume 468, Issue 9 , pp 2372-2376
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- 1. Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, Pavilion A, Redwood City, CA, 94063, USA
- 2. Department of OBGYN and Reproductive Science, University of California, San Francisco, San Francisco, CA, USA