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[Significance of Minimally Invasive Approaches during Primary Hip Arthroplasty - an Update]
J Schmolders1, S Gravius1, D C Wirtz1
1Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn.
Introduction:
Minimally invasive approaches to the hip joint during primary endoprosthetics have been for many years the focus of controversial discussion. Minimally invasive approaches offer soft tissue protecting implantations clear advantages regarding early postoperative functional results and reduced intraoperative blood loss.
Method:
On the basis of comprising literary research the available primary and secondary literature is evaluated - the advantages and disadvantages of minimally invasive approaches at the hip joint are discussed in relation to traditional approaches.
Results:
The available primary and secondary literature verifies that the advantages of minimally invasive approaches at the hip joint include functional outcome in the early postoperative phase. In comparison to standard approaches there are no differences in the functional outcome after 12 months follow-up. Additionally, reduced length of operation, reduced blood loss and shorter stationary stay are confirmed. Studies relating to degrees of evidence I and II, which concern the medium- and long-term results of minimally invasive approaches in comparison to the established standard approaches, are not available. The available systematic reviews and meta-analyses merely allow a global evaluation of the primary literature on minimally invasive approaches, without thereby differentiating between the established standard approaches and the modified pendant according to minimally invasive criteria. There is a lack of knowledge with regard to in-vivo imaging data (MRI) as a potential evidence for reduction of muscular trauma by using minimally invasive approaches.
Conclusion:
Presently, the available literature does not allow definitive assessment regarding the significance of minimally invasive approaches at the hip joint. Future, random-controlled studies are necessary in order to compare the reliable (long-term) results of the established standard approaches with the hip approaches according to minimally invasive criteria. As long as sufficient long-term results regarding the complication and revision rates of minimally invasive approaches are not available, the method cannot be recommended as "gold standard."
