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Minimally Invasive Intermuscular Approaches Versus Conventional Approaches in Total Hip Arthroplasty: A Systematic
Kevin Clesham1, Gerard A Sheridan2, Nelson V Greidanus2
1Royal College of Surgeons in Ireland, Dublin, Ireland.
The Journal of Arthroplasty
|March 29, 2022
Summary
Minimally invasive (MI) hip replacement surgery shows no superiority over conventional methods. A systematic review and meta-analysis found equivalent clinical and functional outcomes for MI and traditional total hip arthroplasty approaches.
Area of Science:
- Orthopedic Surgery
- Surgical Techniques
Background:
- The superiority of Minimally Invasive (MI) approaches over conventional techniques in total hip arthroplasty (THA) is not yet established in the literature.
- Existing research lacks definitive evidence comparing MI and conventional THA methods for clinical and functional outcomes.
Purpose of the Study:
- To systematically review and determine if minimally invasive approaches are superior to conventional approaches in total hip arthroplasty for clinical and functional outcomes.
- To conduct a meta-analysis of level 1 evidence to assess the superiority of MI over conventional THA approaches for clinical outcomes.
Main Methods:
- A systematic review and meta-analysis were performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
- Searches included PubMed, Cochrane Library, ClinicalTrials.gov, EU clinical trials register, and ICTRP (WHO) using MeSH terms: 'minimally invasive', 'muscle-sparing', 'THA', 'THR', 'hip arthroplasty', and 'hip replacement'.
- Studies comparing MI to conventional THA approaches were included. 1,282 MI THAs and 1,351 conventional THAs from 20 identified studies were analyzed.
Main Results:
- No significant differences were found between MI and conventional THA approaches for all evaluated clinical outcomes, including all-cause revision (P=.959), aseptic revision (P=.894), instability (P=.894), infection (P=.669), and periprosthetic fracture (P=.940).
- Functional outcomes at early and intermediate follow-up also showed no difference between the MI and conventional groups (P=.38).
- A random-effects meta-analysis of exclusively Level I studies confirmed no difference in aseptic revision (P=.461) or other outcomes between the two surgical approaches.
Conclusions:
- Intermuscular MI approaches for total hip arthroplasty are equivalent to conventional approaches regarding revision rates, infection, dislocation, fracture incidence, and functional outcomes.
- The findings are supported by a meta-analysis of high-level (Level I) evidence, indicating comparable efficacy between MI and conventional THA techniques.
