Abstract
Objective
A poll was initially attempted to elucidate what type of skin incision would be preferred by the patients. The retrospective analysis of index cases was preformed to reveal the gains and losses of small incision transgluteal THA.
Materials and methods
We performed a poll on the preferred type of skin incision to the patients, their families and the medical personnel in orthopedic department in a face-to-face manner. According to the result of the poll, we changed approaches from a standard transgluteal to a small incision transgluteal approach. Each 20 consecutive index patients that underwent standard or small-incision transgluteal THA were followed and compared for more than 2 years.
Results
The small incision THA group showed more rapid mobilization, shorter hospital stay, and better early satisfaction. However, no clinical benefits of small incision were observed after 6-weeks postoperatively. There were significant variations in implant alignments. More early major complications such as dislocation, intraoperative femoral fracture or leg length inequalities occurred in the small incision group.
Conclusions
The use of a small incision in THA resulted in subtle and temporary gains, at the cost of several major early complications. Now we perform THA with definitely smaller incision than before but we do believe that performing a stable and well-aligned THA is far more important than the length or amount of surgical dissection.
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References
Archibeck MJ, White RE Jr (2004) Learning curve for the two-incision total hip replacement. Clin Orthop Relat Res 429:232–238
Bal BS, Haltom D, Aleto T, Barrette M (2006) Early complications of primary total hip replacement performed with a two-incision minimally invasive technique. Surgical technique. J Bone Joint Surg Am 88(Suppl 1 Pt 2):221–233
Berger RA (2004) Mini-incision total hip replacement using an anterolateral approach: technique and results. Orthop Clin North Am 35:143–151
Berger RA, Jacobs JJ, Meneghini RM, Valle CD, Paprosky W, Rosenberg AG (2004) Rapid rehabilitation and recovery with minimally invasive total hip arthroplasty. Clin Orthop Relat Res 429:239–247
Bottner F, Delgado S, Sculco TP (2006) Minimally invasive total hip replacement: the posterolateral approach. Am J Orthop 35:218–224
Burtin KL, Rottinger H (2004) Anterolateral mini-incision hip replacement surgery: a modified Watson–Jones approach. Clin Orthop Relat Res 429:248–255
Chimento G, Sculco TP (2001) Minimally invasive total hip arthroplasty. Oper Tech Orthop 11:270–273
De Beer J, Petruccelli D, Zalzal P, Winemaker MJ (2004) Single-incision, minimally invasive total hip arthroplasty. Length doesn’t matter. J Arthroplasty 19:945–950
Goldstein WM, Branson JJ, Berland KA, Gordon AC (2003) Minimal-incision total hip arthroplasty. J Bone Joint Surg Am 85(Suppl 4):33–38
Hartzband MA (2004) Posterolateral minimal incision for total hip replacement: technique and early results. Orthop Clin North Am 35:119–129
Howell JR, Masri BA, Duncan CP (2004) Minimally invasive versus standard incision anterolateral hip replacement: a comparative study. Orthop Clin North Am 35:153–162
Mardones R, Pagnano MW, Nemanich JP, Trousdale RT (2005) Muscle damage after total hip arthroplasty done with the two-incision and mini-posterior techniques. Clin Orthop Relat Res 441:63–67
O’Brien DA, Rorabeck CH (2005) The mini-incision direct lateral approach in primary total hip arthroplasty. Clin Orthop Relat Res 441:99–103
Ogonda L, Wilson R, Archbold P et al (2005) A minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes. J Bone Joint Surg Am 87:701–710
Pagnano MW, Leone J, Lewallen DG, Hanssen AD (2005) Two incision THA had modest outcomes and some substantial complications. Clin Orthop Relat Res 441:86–90
Sculco TP, Jordan LC, Walter WL (2004) Minimally invasive total hip arthroplasty: the Hospital for Special Surgery experience. Orthop Clin North Am 35:137–142
Siguier T, Siguier M, Brumpt B (2004) Mini-incision anterior approach does not increase dislocation rate. A study of 1,037 total hip replacement. Clin Orthop Relat Res 426:164–173
Suzuki K, Kawachi S, Sakai H, Nanke H, Morita S (2004) Mini-incision total hip arthroplasty: a quantitative assessment of laboratory data and clinical outcomes. J Orthop Sci 9:571–575
Wenz JF, Gurkan I, Jibodh SR (2002) Mini-incision total hip arthroplasty: a comparative assessment of perioperative outcomes. Orthopedics 25:1031–1043
Woolson ST, Mow CS, Syquia JF, Lannin JV, Shurman DJ (2004) Comparison of primary total hip replacements performed with a standard incision or a mini-incision. J Bone Joint Surg Am 86:1353–1358
Wright JM, Crockett HC, Delgado S, Lyman S, Madsen M, Sculco TP (2004) Mini-incision for total hip arthroplasty: a prospective, controlled investigation with 5-year follow-up evaluation. J Arthroplasty 19:538–545
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Han, K.Y., Garino, J.P. & Rhyu, K.H. Gains and losses of small incision lateral total hip arthroplasty: what the patients want and its index case result. Arch Orthop Trauma Surg 129, 635–640 (2009). https://doi.org/10.1007/s00402-008-0682-y
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DOI: https://doi.org/10.1007/s00402-008-0682-y