Clinical Orthopaedics and Related Research®

, Volume 468, Issue 9, pp 2372–2376

Minimal Incision Surgery as a Risk Factor for Early Failure of Total Hip Arthroplasty

  • Bradley P. Graw
  • Steven T. Woolson
  • Heather G. Huddleston
  • Stuart B. Goodman
  • James I. Huddleston
Symposium: Complications of Hip Arthroplasty

Abstract

Background

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.

Questions/purposes

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.

Methods

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.

Results

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.

Conclusions

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.

References

  1. 1.
    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.CrossRefPubMedGoogle Scholar
  2. 2.
    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.PubMedGoogle Scholar
  3. 3.
    Bozic K. Single mini-incision has some perioperative advantages over standard-incision total hip replacement. J Bone Joint Surg Am. 2009;91:1279.CrossRefPubMedGoogle Scholar
  4. 4.
    Bozic KJ, Beringer D. Economic considerations in minimally invasive total joint arthroplasty. Clin Orthop Relat Res. 2007;463:20–25.PubMedGoogle Scholar
  5. 5.
    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.CrossRefPubMedGoogle Scholar
  6. 6.
    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.CrossRefPubMedGoogle Scholar
  7. 7.
    Chimento GF, Pavone V, Sharrock N, Kahn B, Cahill J, Sculco TP. Minimally invasive total hip arthroplasty. J Arthroplasty. 2005;20:139–144.CrossRefPubMedGoogle Scholar
  8. 8.
    Crowe JF, Sculco TP, Kahn B. Revision total hip arthroplasty: hospital cost and reimbursement analysis. Clin Orthop Relat Res. 2003;413:175–182.CrossRefPubMedGoogle Scholar
  9. 9.
    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.CrossRefPubMedGoogle Scholar
  10. 10.
    Hungerford DS. Minimally invasive total hip arthroplasty: in opposition. J Arthroplasty. 2004;19(Suppl 1):81–82.CrossRefPubMedGoogle Scholar
  11. 11.
    Kim YH. Comparison of primary total hip arthroplasties performed with a minimally invasive technique or a standard technique. J Arthroplasty. 2006;21:1092–1098.CrossRefPubMedGoogle Scholar
  12. 12.
    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.CrossRefPubMedGoogle Scholar
  13. 13.
    Lubowitz JH, Sahasrabudhe A, Appleby D. Minimally invasive surgery in total knee arthroplasty: the learning curve. Orthopedics. 2007;30:80–82.PubMedGoogle Scholar
  14. 14.
    Masonis J, Thompson C, Odum S. Safe and accurate: learning the direct anterior total hip arthroplasty. Orthopedics. 2008;31(Suppl 2).Google Scholar
  15. 15.
    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.CrossRefPubMedGoogle Scholar
  16. 16.
    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.CrossRefPubMedGoogle Scholar
  17. 17.
    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.CrossRefPubMedGoogle Scholar
  18. 18.
    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.CrossRefPubMedGoogle Scholar
  19. 19.
    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.CrossRefPubMedGoogle Scholar
  20. 20.
    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.CrossRefPubMedGoogle Scholar
  21. 21.
    Sculco TP. Minimally invasive total hip: in the affirmative. J Arthroplasty. 2004;19(Suppl 1):78–80.CrossRefPubMedGoogle Scholar
  22. 22.
    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.CrossRefPubMedGoogle Scholar
  23. 23.
    Wall SJ, Mears SC. Analysis of published evidence on minimally invasive total hip arthroplasty. J Arthroplasty. 2008;23(Suppl 7):55–58.CrossRefPubMedGoogle Scholar
  24. 24.
    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.PubMedGoogle Scholar
  25. 25.
    Woolson ST, Pouliot MA, Huddleston JI. Primary total hip arthroplasty using an anterior approach and a fracture table. J Arthroplasty. 2009;24:999–1005.CrossRefPubMedGoogle Scholar
  26. 26.
    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.CrossRefPubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Bradley P. Graw
    • 1
  • Steven T. Woolson
    • 1
  • Heather G. Huddleston
    • 2
  • Stuart B. Goodman
    • 1
  • James I. Huddleston
    • 1
  1. 1.Department of Orthopaedic SurgeryStanford University Medical CenterRedwood CityUSA
  2. 2.Department of OBGYN and Reproductive ScienceUniversity of California, San FranciscoSan FranciscoUSA

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