Standard Transgluteal versus Minimal Invasive Anterior Approach in hip Arthroplasty: A Prospective, Consecutive Cohort Study

Thomas Ilchmann, Silke Gersbach, Lukas Zwicky, Martin Clauss, Thomas Ilchmann, Silke Gersbach, Lukas Zwicky, Martin Clauss

Abstract

A minimally invasive anterior approach (MIS) was compared to a standard lateral approach in primary total hip arthroplasty. Clinical and radiological outcomes were analyzed 6 weeks, 12 weeks, one year and two years after surgery. The duration of surgery was longer, mobility one week after surgery was better and time of hospitalization was shorter for minimally invasive-treated patients. They had less pain during movement, limping, better Harris Hip Score and satisfaction after 6 weeks, which remained after 12 weeks and 1 year, but not after two years. There were two deep infections in the MIS group. Radiological results were not affected. The infections might be a point of concern, but there were no other disadvantages of the MIS approach. In fact, early rehabilitation was facilitated and clinical results were improved. Our results encourage the continuous use of the MIS anterior approach instead of the lateral approach.

Keywords: anterior approach; early rehabilitation; hip replacement; minimal invasive.

Conflict of interest statement

Conflict of interests: the authors declare no potential conflict of interests.

Figures

Figure 1.
Figure 1.
In the anterior approach the intermuscular space between rectus femoris and tensor fascia lata is developed, the lateral parts (musculus iliocapsularis) of the iliopsoas are lift off the capsule, no has to be refixed. The sensoric nervus cutaneaus femoris lateralis is close to the incision and might be damaged during preparation. In the lateral approach the musculus glutaeus medius is split and the musculus glutaeus minimus is lift off its insertion, they have to be refixed. In case of extended muscle split the motoric nervus glutaeus superior might be damaged.
Figure 2.
Figure 2.
In the anterior approach the musculus sartorius and rectus femoris are mobilised anteriorly and the musculus tensor fascia lata posteriorly, respectively. They are kept under the retractor. The muscles can be mobilised cranially without risk of the innervation.

References

    1. Smith TO, Blake V, Hing CB.Minimally invasive versus conventional exposure for total hip arthroplasty: a systematic review and meta-analysis of clinical and radiological outcomes. Int Orthop. 2011;35:173-84
    1. Pospischill M, Kranzl A, Attwenger B, et al. Minimally invasive compared with traditional transgluteal approach for total hip arthroplasty: a comparative gait analysis. J Bone Joint Surg Am. 2010;92:328-37
    1. Bertin KC, Rottinger H.Anterolateral mini-incision hip replacement surgery: a modified Watson-Jones approach. Clin Orthop Relat Res 2004;248-55
    1. Bremer AK, Kalbere F, Pfirrmann CW, et al. Soft-tissue changes in hip abductor muscles and tendons after total hip replacement: comparison between the direct anterior and the transgluteal approaches. J Bone Joint Surg Br. 2011;93: 886-9
    1. Kampa RJ, Prasthofer A, Lawrence-Watt DJ, et al. The internervous safe zone for incision of the capsule of the hip. A cadaver study. J Bone Joint Surg Br. 2007;89: 971-6
    1. Restrepo C, Parvizi J, Pour AE, et al. Prospective randomized study of two surgical approaches for total hip arthroplasty. J Arthroplasty. 2010;25:671-9
    1. Goebel S, Steinert AF, Schillinger J, et al. Reduced postoperative pain in total hip arthroplasty after minimal-invasive anterior approach. Int Orthop. 2012;36:491-8
    1. Lin DH, Jan MH, Liu TK, et al. Effects of anterolateral minimally invasive surgery in total hip arthroplasty on hip muscle strength, walking speed, and functional score. J Arthroplasty. 2007;22:1187-92
    1. Wright JM, Crockett HC, Delgado S, et al. Mini-incision for total hip arthroplasty: a prospective, controlled investigation with 5-year follow-up evaluation. J Arthroplasty. 2004;19:538-45
    1. Ogonda L, Wilson R, Archbold P, et al. A minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes. A prospective, randomized, controlled trial. J Bone Joint Surg Am. 2005;87:701-10
    1. Williams SL, Bachison C, Michelson JD, et al. Component position in 2-incision minimally invasive total hip arthroplasty compared to standard total hip arthroplasty. J Arthroplasty. 2008;23:197-202
    1. Meneghini RM, Smits SA.A Prospective, randomized study of component position in two-incision mis total hip arthroplasty: a preliminary study. Surg Technol Int 2011;XXI:255-60
    1. Lloyd JM, Wainwright T, Middleton RG.What is the role of minimally invasive surgery in a fast track hip and knee replacement pathway? Ann R Coll Surg Engl. 2012;94:148-51
    1. Berger RA, Sanders SA, Thill ES, et al. Newer anesthesia and rehabilitation protocols enable outpatient hip replacement in selected patients. Clin Orthop Relat Res. 2009;467:1424-30
    1. Husted H, Holm G, Jacobsen S.Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta Orthop. 2008;79:168-73
    1. Bauer R, Kerschbaumer F, Poisel S, et al. The transgluteal approach to the hip joint. Arch Orthop Trauma Surg. 1979;95:47-9
    1. O’Brien DA, Rorabeck CH.The mini-incision direct lateral approach in primary total hip arthroplasty. Clin Orthop Relat Res. 2005;441:99-103
    1. Matta JM, Shahrdar C, Ferguson T.Single-incision anterior approach for total hip arthroplasty on an orthopaedic table. Clin Orthop Relat Res. 2005;441:115-24
    1. Haddad RJ, Cook SD, Brinker MR.A comparison of three varieties of noncemented porous-coated hip replacement. J. Bone Joint Surg Br. 1990;72:2-8
    1. Ilchmann T.Radiographic assessment of cup migration and wear after hip replacement. Acta Orthop Scand Suppl. 1997;276:1-26
    1. Krismer M, Bauer R, Tschupik J, et al. EBRA: a method to measure migration of acetabular components. J Biomech 1995;28:1225-36
    1. Jewett BA, Collis DK.High complication rate with anterior total hip arthroplasties on a fracture table. Clin Orthop Relat Res. 2011;469:503-7
    1. Lovell TP.Single-incision direct anterior approach for total hip arthroplasty using a standard operating table. J Arthroplasty. 2008;23:64-8
    1. D’Arrigo C, Speranza A, Monaco E, et al. Learning curve in tissue sparing total hip replacement: comparison between different approaches. J Orthop Traumatol. 2009;10: 47-54
    1. Husted H, Holm G.Fast track in total hip and knee arthroplasty—experiences from Hvidovre University Hospital, Denmark. Injury 2006;37 Suppl 5:S31-5
    1. Mears DC, Mears SC, Chelly JE, et al. THA with a minimally invasive technique, multi-modal anesthesia, and home rehabilitation: factors associated with early discharge? Clin Orthop Relat Res. 2009;467:1412-7
    1. Callanan MC, Jarrett B, Bragdon CR, et al. The John Charnley Award: risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res. 2011;469:319-29
    1. Laffosse JM, Accadbled F, Molinier F, et al. Anterolateral mini-invasive versus posterior mini-invasive approach for primary total hip replacement. Comparison of exposure and implant positioning. Arch Orthop Trauma Surg. 2008;128:363-9

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit