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Mini-incision and standard posterior incision surgery for hip replacement have similar benefits and safety

Berstock JR, Blom AW, Beswick AD A systematic review and meta-analysis of the standard versus mini-incision posterior approach to total hip arthroplasty. J Arthroplasty. 2014;29:1970-82.

Review question

In people having total hip replacement surgery (arthroplasty), how does mini-incision surgery compare with standard posterior incision surgery?

Background

People who have degenerative hip disease, like osteoarthritis, often go on to total hip replacement surgery when all non-surgical treatments have been tried. Hip replacement surgery has good long-term outcomes. Newer, minimally invasive approaches use shorter incisions and potentially have less of an effect on soft tissues (such as muscle) when done by experienced surgeons, and might lead to faster recovery. Surgeons can access the hip joint from the front (anterior), the side (lateral) or the buttock (posterior).

How the review was done

The researchers did a systematic review searching for published studies up to January 2014. They found 16 studies, including 12 randomized controlled trials, with 1424 people (1498 hips were operated on).

In the studies, people were having hip replacement for degenerative hip disease (osteoarthritis). Average age was over 60 years.

Mini-incision (approximately 10 cm or shorter) posterior surgery was compared with standard-incision posterior surgery.

People were followed for between 1.5 months and an average of 5 years.

Outcomes included dislocation of the replaced joint, length of hospital stay after surgery, the Harris hip score (which measures pain, function, deformity, and range of motion), and the WOMAC score (which measures pain, stiffness, and function of the joints).

What the researchers found

The randomized controlled trials were of high quality, and the nonrandomized studies were of medium quality.

People who had mini-incision surgery had shorter hospital stays (0.5 days shorter) and less blood loss than people who had standard incision surgery. For total hip replacements done through a posterior approach, mini-incision and standard incision surgery did not differ for complications from surgery, such as joint dislocations, nerve injury, infections, or clots. They also did not result in important differences in pain and functioning (as measured by the Harris Hip Score or WOMAC score).

Conclusion

In people having hip replacement surgery done with a posterior approach, mini-incision surgery is an effective and safe alternative to standard incision surgery when considering patient-important outcomes.

Mini-incision vs standard incision posterior hip replacement surgery

Outcomes

Number of studies (number of hips)

Mini-incision surgery

Standard incision surgery

Effect of min-incision surgery

Dislocation

13 studies (1198 hips)

1.2%

1.0%

No difference in effect*

Length of hospital stay

8 studies (925 hips)

An average of 2.6 days

An average of 3.1 days

About half a day less

Operating time

14 studies (1386 hips)

 

 

About 4 minutes less

Blood loss during surgery

10 studies (1177 hips)

 

 

About 82 mL (a third of a cup) less blood lost

Total blood loss

3 studies (220 hips)

 

 

About 119 mL (half a cup) less blood lost

*Although the rates for the 2 groups look different, the differences were not statistically significant—this means that the difference could simply be due to chance rather than due to the different treatments.




Glossary

Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

Related Web Resources

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    Osteoporosis Canada recommends everyone over age 65 have routine bone density tests. Start routine testing earlier if you are at increased risk for broken bones. Use the FRAX tool to predict your risk of having a fracture related to osteoporosis (link in this resource).
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