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

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 A systematic review of the published and unpublished literature was conducted to include all randomised and non-randomised controlled trials comparing the clinical and radiological outcomes of minimally invasive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.

Figures

Fig. 1

PRISMA chart

Fig. 2

Funnel plot to assess publication for the most frequently reported outcome—surgical duration. SE (MD) standard error (mean difference)

Fig. 3

Forest plot to illustrate mean difference in Harris hips score between minimally invasive surgery (MIS) and conventional total hip arthroplasty (THA) procedures

Fig. 4

Forest plot to illustrate odds ratio for incidence of iatrogenic nerve injury between minimally invasive surgical (MIS) and conventional total hip arthroplasty (THA) procedures

Fig. 5

Forest plot to illustrate odds ratio for incidence of transient lateral femoral cutaneous nerve injury between minimally invasive surgical (MIS) and conventional total hip arthroplasty (THA) procedures