title: Minimally Invasive versus Classic Procedures in Total Hip Arthroplasty: A Double-blind Randomized Controlled Trial Randomized controlled trial of abductor muscle damage in relation to the surgical approach for primary total hip replacement: minimally invasive anterolateral versus modified direct lateral approach Total hip arthroplasty through a minimally invasive lateral approach--our experience and early results. The impact of minimally invasive total hip arthroplasty on the standard procedure The Mini-incision Direct Lateral Approach in Primary Total Hip Arthroplasty A minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes. A prospective, randomized, controlled trial. Which is more invasive—mini versus standard incisions in total hip arthroplasty? Blood Loss in the Minimally Invasive Posterior Approach to Total Hip Arthroplasty: A Comparative Study Minimally invasive total hip arthroplasty: a randomized controlled prospective trial THE FRANK STINCHFIELD AWARD: Muscle Damage after Total Hip Arthroplasty Done with the Two-incision and Mini-posterior Techniques Minimal-invasive posterior approach for total hip arthroplasty versus standard lateral approach. Rapid Rehabilitation and Recovery with Minimally Invasive Total Hip Arthroplasty Mini-incision for total hip arthroplasty: a prospective, controlled investigation with 5-year follow-up evaluation. Anterolateral minimally invasive total hip arthroplasty: a prospective randomized controlled study with a follow-up of 1 year. Minimally-invasive total hip arthroplasty will improve early postoperative outcomes: a prospective, randomized, controlled trial Mini-incision technique for total hip arthroplasty with navigation. Minimally invasive total hip arthroplasty: a prospective randomized study. Early pain relief and function after posterior minimally invasive and conventional total hip arthroplasty. A prospective, randomized, blinded study. Operative and Patient Care Techniques for Posterior Mini-incision Total Hip Arthroplasty Minimally invasive total hip arthroplasty--our clinical experience.
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 / purpose sDoes minimally invasive hip arthroplasty result in superior clinical outcomes ? Patients and Methods In this double-blind r and omized controlled trial , 120 consecutive primary noncemented THAs in 120 patients were assigned to one of two groups ( MIS or CLASS ) . The r and omization 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 question naires 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 clinical ly 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 Introduction Minimally invasive total hip arthroplasty ( THA ) is cl aim ed to be superior to the st and ard technique , due to the potential reduction of soft tissue damage via a smaller and tissue-sparing approach . As a result of the lack of objective evidence of fewer muscle and tendon defects , controversy still remains as to whether minimally invasive total hip arthroplasty truly minimizes muscle and tendon damage . Therefore , the objective was to compare the influence of the surgical approach on abductor muscle trauma and to analyze the relevance to postoperative pain and functional recovery . Material s and methods Between June 2006 and July 2007 , 44 patients with primary hip arthritis were prospect ively included in the study protocol . Patients underwent cementless unilateral total hip arthroplasty either through a minimally invasive anterolateral approach ( ALMI ) ( n = 21 ) or a modified direct lateral approach ( mDL ) ( n = 16 ) . Patients were evaluated clinical ly and underwent MR imaging preoperatively and at 3 and 12 months postoperatively . Clinical assessment contained clinical examination , performance of abduction test and the survey of a function score using the Harris Hip Score , a pain score using a numeric rating scale ( NRS ) of 0–10 , as well as a satisfaction score using an NRS of 1–6 . Additionally , myoglobin and creatine kinase were measured preoperatively , and 6 , 24 and 96 h postoperatively . Evaluation of the MRI images included fatty atrophy ( rating scale 0–4 ) , tendon defects ( present/absent ) and bursal fluid collection of the abductor muscle . Results Muscle and tendon damage occurred in both groups , but more lateral gluteus medius tendon defects [ mDL 3/12mth . : 6 (37%)/4 ( 25 % ) ; ALMI : 3 (14%)/2 ( 9 % ) ] and muscle atrophy in the anterior part of the gluteus medius [ mean-st and ard ( 12 ) : 1.75 ± 1.8 ; mean-MIS ( 12 ) : 0.98 ± 1.1 ] were found in patients with the mDL approach . The clinical outcome was also poorer compared to the ALMI group . Significantly , more Trendelenburg ’s signs were evident and lower clinical scores were achieved in the mDL group . No differences in muscle and tendon damage were found for the gluteus minimus muscle . A higher serum myoglobin concentration was measured 6 and 24 h postoperatively in the mDL group ( 6 h : 403 ± 168 μg/l ; 24 h : 304 ± 182 μg/l ) compared to the ALMI group ( 6 h : 331 ± 143 μg/l ; 24 h : 268 ± 145 μg/l ) . Conclusion Abductor muscle and tendon damage occurred in both approaches , but the gluteus medius muscle can be spared more successfully via the minimally invasive approach and is accompanied by a better clinical outcome . Therefore , going through the intermuscular plane , without any detachment or dissection of muscle and tendons , truly minimizes perioperative soft tissue trauma . Furthermore , MRI emerges as an important imaging modality in the evaluation of muscle trauma in THA BACKGROUND AIMS Evaluation of : 1 . early clinical and radiographic results of  total hip arthroplasty ( THA ) through a st and ard lateral direct approach , 2 . early clinical and radiographic results of THA through a minimal lateral approach , 3 . comparison of the results of THA in these two groups . MATERIAL AND METHODS 120 THAs ( 60 cementless and 60 cemented ) done in 120 patients due to degenerative changes were evaluated prospect ively . 60 THAs were done through a minimal lateral approach and constituted a study group . 60 THAs were done through a direct lateral approach and constituted a control group . The mean age of the 120 patients ( 98 women and 22 men ) was 45 y.o . ( range : 32 - 67 y.o . ) . The duration of follow-up in the study group was from 6 to 12 months ( mean : 8.5 months ) . The duration of follow-up in the control group was from 10 to 16 months ( mean : 10.5 months ) . Mean preoperative functional status of the study group was 44.5 points according to the Harris hip score . Radiographic evaluation of the results was done according to the criteria of the Joint Committee of the Hip Society , AAOS and SICOT . RESULTS 6 months after THA , clinical results were 92 pts in the study group and 88 pts in the control group . Radiographic outcomes were very good in all 120 patients from both arms : there were no differences between the control and study group . The incidence of complications was similar in both groups . CONCLUSIONS Minimally invasive THA demonstrated its value in the treatment of  degenerative changes of the hip joint  with regard to short-term outcomes . The clinical and radiographic outcomes were comparable between the st and ard and minimally invasive approaches . Success with THA using a minimally invasive approach depends on excellent operative technique and experience with st and ard hip approaches rather than on the use of special instruments Minimally invasive total hip arthroplasty  using a short skin incision is a subject of much debate in the literature . The present study estimates the possible minimal length of the exposure in an unselected patient cohort and compares the lateral mini-incision technique and traditional total hip arthroplasty ( THA ) .  One hundred and two patients were divided into three groups according to the type of surgery and length of incision : mini-incision ( less than 10  cm ) was performed in 38 patients ; midi-incision ( 10–14 cm ) in 43 ; and  st and ard-incision ( longer than 14 cm ) in 21 patients . No statistical difference was found with regard to intraoperative and total blood loss , the rate of complications , and postoperative recovery . Significantly decreased body mass index ( BMI ) , shorter operative time , and higher number of hips with malpositioning of the acetabular cup were found in the mini-incision group . These patients , however , experienced less pain in the early postoperative period and were highly satisfied with the cosmetic results . The length of incision was shortened and optimized ( less than 14 cm ) in 82 % of patients , and mini-incision was performed in 38 patients of this unselected cohort . Because of the underst and able dem and of the patients for less invasive intervention , the surgeon should use a smaller but not necessarily mini-incision with minimal soft tissue trauma that still allows him to perform the procedure well , without compromising the type of implants and the otherwise excellent long-term results . R and omized prospect i ve studies are needed to explore the real value of the minimally invasive total hip arthroplasty . RésuméLa chirurgie arthroplastie de la hanche par voie mini invasive est un sujet de débat et de controverse dans la littérature . Cette étude a pour but d’estimer la longueur minimale de la voie d’abord sur une suite de patients non sélectionnés et de comparer la technique de mini incision avec la technique d’incision traditionnelle antérolatérale .  Cent deux patients ont été divisés en trois groupes , en fonction du type de chirurgie et en fonction de la longueur d’incision . Premier groupe : mini incision moins de 10 cm chez 38 patients , deuxième groupe : incision moyenne 10 à 14 cm chez 43 patients et troisième groupe : incision st and ard , supérieure à 14 cm chez 21 patients . Aucune différence statistique n’a été trouvée pour la perte sanguine et sur le taux des complications post-opératoires . Dans le groupe des mini incisions peu de sujets avaient une surcharge pondérale , par contre , il existait un gr and nombre de hanches avec une mal position de la cupule . Ces patients ont cependant présenté moins de douleur dans la période post-opératoire et ont été très satisfaits du résultat cosmétique . La longueur de l’incision dans la chirurgie prothétique de la hanche peut être raccourcie et la longueur optimum peut être de moins de 14 cm chez 82 % des patients . Une mini incision a été réalisé dans cette série , chez 38 patients du fait de la dem and e des patients pour une chirurgie mini invasive , les chirurgiens ont utilisé une petite incision avec un minimum de traumatisme des tissus mous . Cette mini incision doit donc permettre au chirurgien de réaliser son intervention correctement sans compromission sur le type d ’ implants , ni sur la qualité des résultats à long terme . Il n’y a pas besoin pour cela nécessairement d’une mini incision néanmoins des études prospect ives r and omisées doivent être réalisées pour explorer le vrai résultat de la chirurgie arthroplastie par voie mini invasive Patients are inquiring about  mini-incision primary total hip arthroplasty  with increasing frequency . There are no published r and omized controlled trials to substantiate cl aims that the mini-incision direct lateral approach is better than a st and ard approach . The purpose of our study was to review our initial experience with the mini-incision technique through the direct lateral approach , with the intent of implementing a r and omized controlled trial if the approach could be shown as safe and effective . Of importance was determining if there is any difference in component positioning and if there is any difference in intraoperative or postoperative complications between the two groups . We retrospectively compared a consecutive series of 87 primary total hip arthroplasties . Thirty-four total hip arthroplasties were done using a mini-incision direct lateral approach . The mean abduction angle was 45 ° for both groups . The femoral stem alignment was within five degrees of neutral in 97 % of the mini group and 94 % of the st and ard group . There were no dislocations , infections , neurologic or wound complications . There were no differences in medical complications or blood transfusions . A significant decrease was found regarding body mass index , which reflects the bias in patient selection and lack of r and omization . We conclude that it is safe to continue further study with this approach because as there was no increase in complications or component malpositioning . Level of Evidence : Therapeutic study , Level III ( retrospective comparative study ) . See the Guidelines for Authors for a complete description of levels of evidence BACKGROUND Minimally invasive total hip arthroplasty has stirred substantial controversy with regard to whether it provides superior outcomes compared with total hip arthroplasty performed through longer incisions . The orthopaedic literature is deficient in well- design ed scientific studies to support the clinical superiority of this approach . The objective of this study was to compare the results of a single mini-incision approach with those of a st and ard-incision total hip arthroplasty in the early postoperative period . METHODS Two hundred and nineteen patients ( 219 hips ) admitted for unilateral total hip arthroplasty between December 2003 and June 2004 were r and omized to undergo surgery through a short incision of < or=10 cm or a st and ard incision of 16 cm .  All patients were blinded to the size of the incision for the duration of the hospital stay . The anesthetic , analgesic , and postoperative physiotherapy protocol s were st and ardized , with the staff also blinded to the technique used . A single surgeon , who had performed more than 300 short-incision hip replacements prior to the start of this study and who performs an average of 415 primary total hip replacements a year , performed all procedures through a single-incision posterior approach using a cementless cup and cemented stem . RESULTS The two groups were matched for age , grade according to the system of the American Society of Anesthesiologists , and body mass index . No significant difference was detected with respect to postoperative hematocrit , blood transfusion requirements , pain scores , or analgesic use . We found no difference in early walking ability or length of hospital stay and no difference in component placement , cement-mantle quality , or functional outcome scores at six weeks . The patient variables significantly associated with a probability of early discharge independent of incision length were patient age and preoperative hemoglobin levels ( p < 0.05 ) . The surgical scars contracted significantly over six weeks ( p < 0.05 ) but by a similar proportion of 11 % to 12 % in both groups . CONCLUSIONS Minimally invasive total hip arthroplasty performed through a single-incision posterior approach by a high-volume hip surgeon with extensive experience in less invasive approaches to the hip is safe and reproducible . However , it offers no significant benefit in the early postoperative period compared with a st and ard incision of 16 cm . As it is not known whether lower-volume and less-experienced surgeons can achieve similar results , the mini-incision technique merits further study before wide dissemination and implementation of this family of surgical approaches can be recommended In this study , interleukin-6 ( IL-6 ) , C-reactive protein ( CRP ) , and haemoglobin levels were evaluated to compare the degree of surgical invasion between mini and st and ard incisions in total hip arthroplasty ( THA ) . Sixty-two patients admitted for primary cementless THA were enrolled in this r and omised study . The patients were allocated to have surgery through either a mini incision of < 10 cm or a st and ard incision of 15 cm . In each group , inflammatory responses were evaluated by IL-6 , CRP , and haemoglobin levels before operation and one day after operation . Significant differences were not found in IL-6 , CRP , and haemoglobin levels between both groups . At six months after surgery , there were no significant differences in postoperative Harris hip scores or radiographic evaluations between both groups . In conclusion , a 5.0 cm difference in the skin incision to the hip joint seemed to have no influence on the degree of surgical invasion during THA.RésuméAfin de mesurer l ’ importance de l’agression chirurgicale tissulaire dans les prothèses totales de hanche , incision st and ard , versus mini-invasifs , les niveaux d’Interleukin 6 ( IL-6 ) de protéine C-réactive ( CRP ) et d’hémoglobine doivent être appréciés . 62 patients devant bénéficier d’une prothèse totale de hanche primaire sans ciment ont été enrôlés dans cette étude r and omisée . Ces patients devaient bénéficier soit d’une mini-incision inférieure à 10 cm , soit d’une incision st and ard supérieure à 15 cm . Chaque groupe a été évalué avec ces différents facteurs biologiques avant l’intervention et un jour après intervention . Il n’a été trouvé aucune différence significative dans les deux groupes avec ces différents marqueurs Inteleukin , CRP et hémoglobine . Six mois après la chirurgie pas de différence significative non plus au niveau des scores de Harris ou au niveau de l’évaluation radiographique . En conclusion , la différence d’incision cutanée de 5 cm ne semble pas avoir d’influence sur l ’ importance des lésions des parties molles au cours d’une prothèse totale de hanche AIMS Our primary aim was to evaluate whether there is really less bleeding in patients for whom the minimally invasive posterior approach is used in comparison with the direct lateral approach for primary total hip arthroplasty . Our secondary aim was to evaluate the clinical functional results after six months as well as the postoperative radiographic result . METHODS In a comparative non-r and om prospect i ve study , 76 adult patients underwent elective total hip arthroplasty using one of two approaches . The minimally invasive posterior approach ( 34 cases ; mini-incision group ) was compared with the st and ard direct lateral approach ( 42 cases ; control group ) . RESULTS Lower total estimated bleeding ( means of 1083.5 ml versus 1682.3 ml ; p < 0.001 ) and lower intraoperative bleeding ( means of 745.6 ml versus 1282.8 ml ; p < 0.001 ) were found in the mini-incision group . There was , however , no difference in the volume of blood drained after the operation ( means of 340 ml and 399 ml ; p = 0.77 ) . There was also a difference between the two groups regarding the need for allogenic transfusion ( 8.8 % in the mini-incision group versus 28.6 % , p = 0.02 ) . We observed a better clinical result in the mini-incision group ( p = 0.002 ) despite the lack of difference between the two groups in relation to the radiographic result . DISCUSSION Our results draw attention to the possibility that other authors may have underestimated blood losses when using minimally invasive approaches . CONCLUSION The minimally invasive approach gave rise to a positive final impression with regard to lower blood loss Introduction Advantages of minimally invasive total hip arthroplasty ( THA )  are controversially discussed . Method In this prospect i ve study 51 patients ( 52 hips ) were r and omly allocated to a classical lateral or a minimally invasive approach ( modification of the Hardinge-approach ) . Operating time , intraoperative blood loss , postoperative hemoglobin , muscle enzymes CK and myoglobin were recorded . Radiologically the positioning of the prosthesis was analyzed . WOMAC- and Harris Hip Score ( HHS ) were assessed preoperatively , at discharge , at 6 weeks and 3 months . Results In the minimally invasive group there was a shorter length of surgery , the scores in the WOMAC and HHS were slightly better at discharge and at the 3 months- examination , myoglobin-rise was slightly less . The positioning of the prosthesis was good in both groups . Minimally invasive THA led to a quicker recovery , at 3 months postoperative there was still a slight difference to the st and ard group . Conclusion If these slight differences subside has to be examined in studies with a longer follow-up Some surgeons have suggested that a minimally invasive two-incision approach allows total hip arthroplasty to be done without cutting or damaging any muscle or tendon . To our knowledge that cl aim has not been supported by any published clinical or basic science data . Our purpose in doing this study was to quantify the extent and location of damage to the abductor and external rotator muscles and tendons after two-incision and mini-posterior total hip arthroplasty .  Ten cadavers ( 20 hips ) were studied . In each cadaver one hip r and omly was assigned to the two-incision group and the contralateral hip was assigned to the mini-posterior group . After inserting the total hip arthroplasty components the muscle damage was assessed using a technique described previously . Damage to the muscle of the gluteus medius and gluteus minimus was substantially greater with the two-incision technique than with the mini-posterior technique . Every two-incision total hip replacement caused measurable damage to the abductors , the external rotators , or both . Every mini-posterior hip replacement caused the external rotators to detach during the exposure and had additional measurable damage to the abductor muscles and tendon . We do not support the contention that a two-incision total hip arthroplasty is done without cutting muscle or tendon . None of the two-incision hip replacements were done without cutting , reaming , or damaging the gluteus medius or gluteus minimus muscle or external rotators In this prospect i ve study we compared clinical and radiological results and rehabilitation progress of 64 patients who underwent total hip arthroplasty using the st and ard lateral approach with 64 patients operated with a minimal-invasive ( MIS ) posterior approach .  The outcome of our study did not show any significant differences with regard to patient 's safety such as complication rate and radiological assessment of the cup position . There was no difference in the duration of surgery , blood loss , hospital stay and postoperative leg length discrepancy . Rehabilitation milestones were achieved earlier by MIS patients and three and six months postoperatively , the Harris Hip Score of the MIS group was significantly higher To assess the potential recovery rate of a  minimally invasive total hip replacement technique  with minimal soft tissue disruption , an accelerated rehabilitation protocol was implemented with weightbearing as tolerated on the day of surgery . One hundred consecutive patients were enrolled in this prospect i ve study . Ninety-seven patients ( 97 % ) met all the inpatient physical therapy goals required for discharge to home on the day of surgery ; 100 % of patients achieved these goals within 23 hours of surgery .  Outpatient therapy  was initiated in 9 % of patients immediately , 62 % of patients by 1 week , and all patients by 2 weeks . The mean time to discontinued use of crutches , discontinued use of narcotic pain medications , and resumed driving was 6 days postoperatively . The mean time to return to work was 8 days , discontinued use of any assistive device was 9 days , and resumption of all activities of daily living was 10 days . The mean time to walk ½ mile was 16 days . Furthermore , there were no readmissions , no dislocations , and no reoperations . Therefore , a rapid rehabilitation protocol is safe and fulfills the potential benefits of a rapid recovery with minimally invasive total hip arthroplasty A group of 42 primary total hip arthroplasties performed through an abridged surgical incision ( group 1 ) was prospect ively compared to a cohort of 42 primary total hip arthroplasties performed through a st and ard surgical incision ( group 2 ) . The length of the incision was 8.8 + /- 1.5 cm for group 1 and 23.0 + /- 2.1 cm for group 2 . The groups were not significantly different with respect to age , height , preoperative Harris Hip scores ( HHS ) , estimated blood loss , or length of hospital stay ( P>.05 ) . Group 1 patients had a lower body mass index than group 2 patients ( P<.01 ) . Length of surgery was slightly less for group I ( P = .02 ) . A 0 % incidence was found of infection , nerve palsy , component malposition , and aseptic loosening in both groups . No dislocations occurred in group 1 , and one dislocation occurred in group 2 . Patients in group 1 have expressed considerable enthusiasm regarding the cosmetic appearance of the surgical incisions , and their postoperative HHS are slightly higher than those of group 2 ( P = .042 ) . Total hip arthroplasty can be performed safely and effectively through an abridged surgical incision , but this investigation confirms no dramatic clinical benefit other than cosmetic appeal Anterolateral minimally invasive hip surgery ( ALMIS ) is a challenging procedure that is thought to offer a more expedient and a better functional outcome . Seventy-nine patients receiving primary hip arthroplasty were r and omized .  Röttinger ALMIS technique was used for 42 patients , whereas 41 received the st and ard lateral transgluteal Hardinge approach .  Operative time was longer with ALMIS ( P = .000078 ) , whereas blood loss was less ( P = .008 ) . Surgical and postoperative complication rates , morphine consumption , and length and cost of hospitalization were similar . At 1 year , Harris , Postel and Merle d'Aubigné , and Short Form-36v1 scores were similar . Gait analysis revealed similar results . Computed tomographic analysis revealed no significant difference in implant position , heterotopic ossification , and loosening .  Röttinger ALMIS is a valid approach for hip arthroplasty . However , it offers no advantages at 1 year Background The rehabilitation of patients for total hip arthroplasty is unsatisfactory , especially the prolonged rehabilitation . Aims To explore indications and key points of anterolateral minimally-invasive total hip arthroplasty . Methods 110 patients admitted for unilateral total hip arthroplasty were r and omly selected for surgery with either anterolateral minimally-invasive incision or st and ard posterolateral incision .  Demographic data , perioperative index and postoperative function index were recorded and statistically analyzed . Results No significant difference was detected in operation time , abduction angle , anteversion angle , stem alignment and stem fixation . The incision length , blood loss , perioperative transfusion and 100-mm VAS score at the first 24 h in minimally-invasive group were significantly lower . The Harris hip score and Barthel index were significantly higher in minimally-invasive group at 3 months ’ follow-up , but not significantly different 3 years after operation . Conclusions There are fewer traumas , fewer blood losses and more rapid recovery in this approach This prospect i ve study compares a mini-incision technique and traditional posterior approach for total hip arthroplasty ( THA ) . Thirty-three patients who had undergone a mini-incision THA were matched by diagnosis , gender , average age , and preoperative Harris Hip Score ( HHS ) to 33 patients who had undergone THA using the traditional posterior approach .  The average length of the incision for group 1 was 11.7 cm ( range , 7.3 - 13.0 ) and for group 2 was 20.2 cm ( range , 14.8 - 26.0 ) . At the 3-month follow-up , patients in the mini-incision group had significant improvement in limp ( P<.05 ) and ability to climb stairs ( P < .01 ) compared with the traditional group . At the 6 month follow-up , the mini-incision group was significantly better in terms of limp ( P < .05 ) , distance walked ( P<.001 ) , and stairs ( P < 0.001 ) . There was no significant difference between groups for pain , function , or range of motion at the 1-year follow-up examination Patients without prior hip surgery and body mass index lower than 30 undergoing primary total hip arthroplasty were eligible to participate in a r and omized prospect i ve study comparing a minimally invasive with a st and ard approach . The patients were r and omized  to receive incisions  of 8 cm ( group A , n = 28 ) or 15 cm ( group B , n = 32 ) . The groups were similar demographically . Patients in group A had significantly less intraoperative blood loss ( P < .003 ) and less total blood loss ( P < .009 ) . Fewer patients in group A limped at 6 weeks ( P < .04 ) . Operative time , transfusion requirements , narcotic usage , length of hospital stay , achievement of rehabilitation milestones , cane usage , and complications were similar in both groups . There was no difference between the groups at 1- and 2-year follow-up . Compared with a st and ard incision , patients who underwent a minimally invasive total hip arthroplasty demonstrated decreased blood loss and limped less at 6-week follow-up BACKGROUND Few prospect i ve r and omized studies have demonstrated benefits of minimally invasive total hip arthroplasty when compared with conventional total hip arthroplasty . We hypothesized that patients treated with a posterior mini-incision would have better results than those treated with a posterior long incision with regard to the achievement of established goals for pain relief and functional recovery permitting hospital discharge by the second postoperative day . METHODS Sixty of 231 eligible patients were r and omized ( with thirty in each group ) to have a total hip arthroplasty performed through either a posterior mini-incision ( 10 + /- 2 cm ) or a traditional long incision ( 20 + /- 2 cm ) . After completion of the total hip arthroplasty , the mini-incision group underwent extension of the skin incision to 20 cm . Patients were evaluated on the basis of self-determined pain scores , requirements for pain medicine , need for assistive gait devices , and time until discharge . Gait analysis provided objective functional assessment . RESULTS The average hospital stay was 63.2 + /- 13.3 hours in the mini-incision group and 73.6 + /- 23.5 hours in the long-incision group ( p = 0.04 ) . More patients with a mini-incision were discharged by the second postoperative day ( p = 0.003 ) and more were using just a single assistive device at the time of discharge ( p = 0.005 ) . As scored on a verbal analog scale of 0 to 10 points , patients with a mini-incision had less pain on each postoperative day and the pain score remained significantly lower at the time of discharge ( mean , 2.2 + /- 1.0 points compared with 3.1 + /- 0.9 points in the long-incision group ; p = 0.002 ) . After hospital discharge , there were no clinical differences in pain or function between the two groups of patients . CONCLUSIONS Compared with conventional total hip arthroplasty performed through a posterior incision , posterior minimally invasive total hip arthroplasty result ed in better early pain control , earlier discharge to home , and less use of assistive devices . Subsequent evaluations at six weeks and three months showed equivalency between the clinical results in the two groups . LEVEL OF EVIDENCE Therapeutic Level Technical and patient care improvements have occurred with the posterior mini-incision total hip arthroplasty . We hypothesized that these changes would provide better results for patients . The clinical and radiographic results of 100 total hip arthroplasties done with the posterior mini incision between January 2004 and October 2004 were compared with 100 mini-incision total hip arthroplasties done between December 2001 and September 2002 . There were no differences in diagnosis , age , and body mass index of the patients in each group . Component positions were not compromised in either group . There were improvements in the 2004 group with decreased hospital stay , reduction of postoperative pain and opioid analgesic use , reduced use of assistive devices , and earlier muscle recovery . In the 2004 group there were no complications of infection , dislocation , or sciatic palsy . The posterior mini-incision operation has shown improved results with experience and changes in technique and patient care treatment . Level of Evidence : Therapeutic study , Level IV ( case series ) . See the Guidelines for Authors for a complete description of levels of evidence BACKGROUND Minimally invasive prosthetic hip surgery ( MIS ) attempts to minimise the extent of the operation . The aim of the study was to describe minimally invasive hip surgery and to present early clinical experience of the authors . MATERIAL AND METHODS 41 minimally invasive hip replacements through a posterior approach were carried out at the Orthopaedic Department of the Postgraduate Medical Education Centre in Otwock between 2004 and 2006 . 29 of those patients were included into the study , of whom 23 presented for follow-up . A control group consisted of 29 r and omly selected patients operated on using the classical method . Patients qualified for MIS had a BMI below 30 and a structurally normal hip joint with a good range of motion .  RESULTS Early results were subjected to a statistical analysis of 20 parameters . CONCLUSION 1 . The analysis showed that statistically significant baseline differences between MIS and traditionally treated patients included only BMI scores , structure of the hip joint and range of motion . 2 . Implantation of a hip endoprosthesis in a MIS procedure does not differ from the traditional operation utilising a posterior access except for skin incision length
target: There was no major difference in the rate of complications .
  Conclusions Short-term recovery favors limited incision over st and ard incision THA .
background: Background The literature comparing  limited incision and st and ard incision THAs  is confusing regarding whether limited incision THA improves short-term recovery without compromising long-term durability and survival .
  Further , previously published meta-analyses can not conclude that limited incision THA is better .
  With new data , we seek to discover if the answers now exist .
  Purpose We used meta- analysis to compare surgical and hospitalization data , clinical outcomes , and complication rates , and thus ( 1 ) confirm whether limited incision THA is at least comparable to st and ard incision THA ; and ( 2 ) determine whether limited incision THA is an improvement over st and ard incision THA .