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Published on: September 7, 2022
Is minimally invasive surgery less invasive in total hip replacement? A pilot study
P Pilot1, B Kerens, W F Draijer
1Department of Orthopaedics, Reinier de Graaf Hospital, The Netherlands. Peter_pilot@hotmail.com
Abstract:
It has been suggested that minimally invasive surgery (MIS) in total hip replacement (THR) is less traumatic than standard techniques. This study was designed to address the question of whether an anterior MIS approach generates less inflammation and muscle damage than the standard posterolateral (PL) approach. Inflammation parameters such as interleukin-6 (IL-6), muscle damage parameters like heart type fatty acid binding protein (H-FABP), and haemoglobin (Hb) levels were determined pre-operatively and at five consecutive points post-operatively in 10 patients operated through a MIS anterior approach and in 10 patients operated through a PL approach. The mean IL-6 concentration increased from 3 pg/ml in both groups pre-operatively to 78.5 pg/ml (PL group) vs 74.8 pg/ml (MIS group) at 6 hours post-operatively and reached a maximum of 100 pg/ml (PL group) vs 90.5 pg/ml pg/ml (MIS group) after 24 hours. Up to this time point, there was a decrease in both groups. The post-operative mean H-FABP concentration increased to 10.7 microg/l in the PL group vs 15.8 microg/l in the MIS group. It formed a plateau and decreased after 24 hours post-operatively. The Hb levels were 14.5 g/dl before surgery and decreased to 10.7 g/dl (PL group) and 10.0 g/dl (MIS group) at 72 hours post-operatively. No significant differences were found between the two approaches either in inflammation and muscle damage or blood loss. Although the absence of a learning curve may explain the lack of a difference between both techniques, we speculate that the term MIS is at least doubtful in terms of being less traumatic.
Insights
Minimally invasive surgery (MIS) for total hip replacement (THR) did not show less inflammation or muscle damage compared to the standard posterolateral (PL) approach. This study questions whether MIS is truly less traumatic in THR procedures.
Area of Science:
- Orthopedic Surgery
- Surgical Innovation
- Biomarkers of Tissue Injury
Background:
- Minimally invasive surgery (MIS) is proposed to be less traumatic than standard techniques in total hip replacement (THR).
- The anterior MIS approach is compared against the standard posterolateral (PL) approach to evaluate trauma levels.
Purpose of the Study:
- To compare the inflammatory response and muscle damage between anterior MIS and PL approaches in THR.
- To assess differences in blood loss between the two surgical techniques.
Main Methods:
- A comparative study involving 20 patients undergoing THR (10 MIS anterior, 10 PL).
- Measurement of interleukin-6 (IL-6), heart-type fatty acid binding protein (H-FABP), and hemoglobin (Hb) levels pre-operatively and at multiple post-operative time points.
- Analysis of inflammatory markers, muscle damage indicators, and blood loss.
Main Results:
- No significant differences were observed in IL-6 levels, H-FABP concentrations, or Hb levels between the MIS and PL groups.
- Both groups showed similar patterns of increase and decrease in inflammatory and muscle damage markers post-operatively.
- Blood loss was comparable between the anterior MIS and PL approaches.
Conclusions:
- The anterior MIS approach for THR did not demonstrate reduced inflammation or muscle damage compared to the standard PL approach.
- The findings suggest that the term 'minimally invasive' may be questionable regarding reduced trauma in THR.
- Further investigation is needed, considering potential learning curve effects, to definitively assess the trauma associated with MIS in THR.
