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Minimally invasive versus classic procedures in total hip arthroplasty: a double-blind randomized controlled trial.

Goosen JH, Kollen BJ, Castelein RM, Kuipers BM, Verheyen CC - Clin. Orthop. Relat. Res. (2010)

Bottom Line: For the patients in the MIS group (average 7.8 cm incision length), statistically significant increased mean HHSs were seen compared with the CLASS group at 6 weeks and 1 year.The minimal invasive approach in THA did not show a clinically relevant superior outcome in the first postoperative year.Level I, therapeutic study.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery and Traumatology, Isala Clinics, PO Box 10500, 8000 GM Zwolle, The Netherlands. j.h.m.goosen@isala.nl

ABSTRACT

Background: For total hip arthroplasty (THA), minimally invasive surgery (MIS) uses a smaller incision and less muscle dissection than the classic approach (CLASS), and may lead to faster rehabilitation.

Questions/purposes: Does minimally invasive hip arthroplasty result in superior clinical outcomes?

Patients and methods: In this double-blind randomized controlled trial, 120 consecutive primary noncemented THAs in 120 patients were assigned to one of two groups (MIS or CLASS). The randomization sequence was stratified for two groups of surgeons, ie, those using a posterolateral approach (PL-CLASS or PL-MIS) and those using an anterolateral approach (AL-CLASS or AL-MIS). Length of the incisions was 18 cm for the CLASS procedures. MIS incisions were extended at the skin level to 18 cm at the end of the procedure. The primary end point was the Harris hip score (HHS) at 6 weeks postoperatively. Patient-centered questionnaires were obtained preoperatively and after 6 weeks and 1 year.

Results: For the patients in the MIS group (average 7.8 cm incision length), statistically significant increased mean HHSs were seen compared with the CLASS group at 6 weeks and 1 year. This difference was small and mainly caused by the favorable results of the PL-MIS. In the MIS group, surgical time was longer. A learning curve was observed based on operation time and complication rate. Although not statistically significant, the perioperative complication rate was rather high in the (anterolateral) MIS group.

Conclusions: The minimal invasive approach in THA did not show a clinically relevant superior outcome in the first postoperative year.

Level of evidence: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Related in: MedlinePlus

The trial profile is shown in this diagram. BMI = body mass index; MIS = minimally invasive surgery; AL-MIS = anterolateral MIS; PL-MIS = posterolateral MIS; CLASS = classic approach; AL-CLASS = anterolateral CLASS; PL-CLASS = posterolateral CLASS.
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Fig1: The trial profile is shown in this diagram. BMI = body mass index; MIS = minimally invasive surgery; AL-MIS = anterolateral MIS; PL-MIS = posterolateral MIS; CLASS = classic approach; AL-CLASS = anterolateral CLASS; PL-CLASS = posterolateral CLASS.

Mentions: One hundred twenty patients were enrolled in the study. (Fig. 1) Missing value analysis shows 3.3% of the primary end point data, HHS at 6 weeks, and 9.2% at 1 year were missing. In two cases (AL-MIS), the perioperative treatment protocol had to be violated; after reaming, the situation was evaluated as unfit for a noncemented cup. These patients received reversed hybrid prostheses and continued the study program according to the intention-to-treat principle. Three patients were unavailable for clinical and radiologic evaluations at 6 weeks and 1 year postoperatively (one repatriation, two revisions). Six patients were not analyzed at 1-year followup postoperatively (four revisions, one death, and one debrided infected prosthesis). After the 1-year followup, 46% of the MIS patients and 45% of the CLASS patients rightfully thought they were treated this way. The investigator correctly allocated the perceived procedure in 57% of the cases in the MIS group and 52% in the CLASS group.Fig. 1


Minimally invasive versus classic procedures in total hip arthroplasty: a double-blind randomized controlled trial.

Goosen JH, Kollen BJ, Castelein RM, Kuipers BM, Verheyen CC - Clin. Orthop. Relat. Res. (2010)

The trial profile is shown in this diagram. BMI = body mass index; MIS = minimally invasive surgery; AL-MIS = anterolateral MIS; PL-MIS = posterolateral MIS; CLASS = classic approach; AL-CLASS = anterolateral CLASS; PL-CLASS = posterolateral CLASS.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3008875&req=5

Fig1: The trial profile is shown in this diagram. BMI = body mass index; MIS = minimally invasive surgery; AL-MIS = anterolateral MIS; PL-MIS = posterolateral MIS; CLASS = classic approach; AL-CLASS = anterolateral CLASS; PL-CLASS = posterolateral CLASS.
Mentions: One hundred twenty patients were enrolled in the study. (Fig. 1) Missing value analysis shows 3.3% of the primary end point data, HHS at 6 weeks, and 9.2% at 1 year were missing. In two cases (AL-MIS), the perioperative treatment protocol had to be violated; after reaming, the situation was evaluated as unfit for a noncemented cup. These patients received reversed hybrid prostheses and continued the study program according to the intention-to-treat principle. Three patients were unavailable for clinical and radiologic evaluations at 6 weeks and 1 year postoperatively (one repatriation, two revisions). Six patients were not analyzed at 1-year followup postoperatively (four revisions, one death, and one debrided infected prosthesis). After the 1-year followup, 46% of the MIS patients and 45% of the CLASS patients rightfully thought they were treated this way. The investigator correctly allocated the perceived procedure in 57% of the cases in the MIS group and 52% in the CLASS group.Fig. 1

Bottom Line: For the patients in the MIS group (average 7.8 cm incision length), statistically significant increased mean HHSs were seen compared with the CLASS group at 6 weeks and 1 year.The minimal invasive approach in THA did not show a clinically relevant superior outcome in the first postoperative year.Level I, therapeutic study.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery and Traumatology, Isala Clinics, PO Box 10500, 8000 GM Zwolle, The Netherlands. j.h.m.goosen@isala.nl

ABSTRACT

Background: For total hip arthroplasty (THA), minimally invasive surgery (MIS) uses a smaller incision and less muscle dissection than the classic approach (CLASS), and may lead to faster rehabilitation.

Questions/purposes: Does minimally invasive hip arthroplasty result in superior clinical outcomes?

Patients and methods: In this double-blind randomized controlled trial, 120 consecutive primary noncemented THAs in 120 patients were assigned to one of two groups (MIS or CLASS). The randomization sequence was stratified for two groups of surgeons, ie, those using a posterolateral approach (PL-CLASS or PL-MIS) and those using an anterolateral approach (AL-CLASS or AL-MIS). Length of the incisions was 18 cm for the CLASS procedures. MIS incisions were extended at the skin level to 18 cm at the end of the procedure. The primary end point was the Harris hip score (HHS) at 6 weeks postoperatively. Patient-centered questionnaires were obtained preoperatively and after 6 weeks and 1 year.

Results: For the patients in the MIS group (average 7.8 cm incision length), statistically significant increased mean HHSs were seen compared with the CLASS group at 6 weeks and 1 year. This difference was small and mainly caused by the favorable results of the PL-MIS. In the MIS group, surgical time was longer. A learning curve was observed based on operation time and complication rate. Although not statistically significant, the perioperative complication rate was rather high in the (anterolateral) MIS group.

Conclusions: The minimal invasive approach in THA did not show a clinically relevant superior outcome in the first postoperative year.

Level of evidence: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Show MeSH
Related in: MedlinePlus