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Minimally invasive versus conventional exposure for total hip arthroplasty: a systematic review and meta-analysis of clinical and radiological outcomes

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Abstract

Over the past decade, minimally invasive surgery has gained popularity as a means of optimising early postoperative rehabilitation and increasing patient satisfaction and cosmesis following total hip arthroplasty (THA). However, this surgical exposure has also been associated with increased risk of iatrogenic nerve injury and implant mal-positioning due to limited visibility compared to conventionally larger surgical incisions. The purpose of this meta-analysis was to compare the outcomes of these two surgical exposures. A systematic review of the published and unpublished literature was conducted to include all randomised and non-randomised controlled trials comparing the clinical and radiological outcomes of minimally invasive and conventional THA procedures. In total, 28 studies met the eligibility criteria and included 2,849 hips, i.e. 1,428 minimally invasive compared to 1,421 conventional THAs. The meta-analysis of the current evidence base showed that minimally invasive THA is associated with a significantly increased risk of transient lateral femoral cutaneous nerve palsy (p = 0.006) with no significantly better outcome.

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Acknowledgements

We thank the library staff at the Norfolk and Norwich University Hospital’s Sir Thomas Browne Library for their assistance in gathering the articles used in this review. We would also like to thank Professor Young-Hoo Kim, MokDong Hospital, Seoul, Korea; Dr J Ricardo Negreiros Vicente, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Dr Thomas P. Sculco, Hospital for Special Surgery, New York, USA; Professor Qingsheng Zhu, Xijing Hospital, China; Marie Lawlor, Musgrave Park Hospital, Belfast, Northern Ireland; Mr Lawrence Dorr, Arthritis Institute, Inglewood, California, USA; and Professor Steve Woolson, Stanford University Hospital, Stanford, California, USA, for providing additional data used as part of the meta-analysis and for reviewing the results of our search strategy.

Conflict of interest

The authors declare that they have no conflict of interest

Funding

No funds were received to undertake or relating to this study.

Ethical approval

Ethical approval was not required for this study design.

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Authors and Affiliations

  1. Faculty of Health, Queen’s Building, University of East Anglia, Norwich, NR4 7TJ, UK

    Toby O. Smith

  2. Physiotherapy Department, Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK

    Vicky Blake

  3. Department of Trauma and Orthopaedic, St George’s Hospital, Tooting, London, SW17 0QT, UK

    Caroline B. Hing

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  1. Toby O. Smith
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Correspondence to Toby O. Smith.

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Smith, T.O., Blake, V. & Hing, C.B. Minimally invasive versus conventional exposure for total hip arthroplasty: a systematic review and meta-analysis of clinical and radiological outcomes. International Orthopaedics (SICOT) 35, 173–184 (2011). https://doi.org/10.1007/s00264-010-1075-8

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