title: Component position following total hip arthroplasty through a miniinvasive posterolateral approach. Total hip arthroplasty through a minimally invasive lateral approach--our experience and early results. A minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes. A prospective, randomized, controlled trial. [Minimally invasive total hip arthroplasty with anterior incision]. The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. Minimally invasive compared with traditional transgluteal approach for total hip arthroplasty: a comparative gait analysis. A lateral minimal-incision technique in total hip replacement: a prospective, randomizes, controlled trial. Comparison of primary total hip arthroplasties performed with a minimally invasive technique or a standard technique: a prospective and randomized study. Minimally invasive total hip arthroplasty: a prospective randomized study. Minimally invasive hip arthroplasty: what role does patient preconditioning play? [Minimally invasive vs. transgluteal total hip replacement. A 3-month follow-up of a prospective randomized clinical study]. Comparison of skin blood flow between mini- and standard-incision approaches during total hip arthroplasty.
abstract: Implant malposition and poor fixation are potential risks of compromising long-term results after total hip arthroplasty performed with a minimally invasive technique . Between September 2000 and February 2002 , 120 cemented primary total hip arthroplasties were performed at the authors ' institutions in patients with primary osteoarthritis of the hip and with BMI lower than 35 . In 60 of these cases selected at r and om , a posterolateral incision no longer than 10 cm was used . The other 60 THA 's were performed through a st and ard posterolateral approach . The inclination and anteversion of the cup and the position of the femoral stem were assessed on radiographs and statistically evaluated . In the miniinvasive group , the average inclination angle of the cup was 42.3 degrees ( range : 36 to 52 degrees ) and the anteversion angle 13.6 degrees ( range : 6 to 29 degrees ) . The coronal alignment of the femoral component was within 3 degrees of neutral in 54 cases ( 90.0 % ) . Following conventional implantation in the other group , the average cup inclination angle was 42.4 degrees ( range : 35 to 50 degrees ) and the anteversion angle 13.6 degrees ( range : 8 to 24 degrees . A total of 53 stems ( 88.3 % ) were implanted optimally . Statistical analysis found no significant difference between the two groups regarding components position . These findings suggest that using a smaller posterolateral incision as was done in this study does not introduce a potential risk of compromising long-term results 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 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 OBJECTIVE To report the clinical outcome of minimally invasive total hip arthroplasty  with anterior incision . METHODS One hundred and twenty cases were r and omly divided into two groups . Sixty cases ( group 1 ) who had undergone a mini-invasive THA  were compared with 60 cases ( group 2 ) who had undergone THA with st and ard posterolateral incision .  The operation time , length of incision , blood loss , anteversion angle of acetabulum cup , Harris score and complications were observed . RESULT The average operation time was almost the same ; The average length of incision for group 1 was 7.9 cm ( 7.4 - 9.0 cm ) and 16.3 cm ( 14 - 22 cm ) for group 2 ( P < 0.01 ) . The average blood loss for group 1 was 350 ml ( 250 - 530 ml ) and 650 ml ( 400 - 1200 ml ) for group 2 , there was significant difference between two groups ( P < 0.05 ) . According to the postoperative X-ray , the mean anteversion angles of cup were 24 degrees ( 19 degrees - 27 degrees ) for group 1 and 19 degrees ( 15 degrees - 22 degrees ) for group 2 . The average length of post-operative hospital stay was 7 days ( 5 - 8 days ) in group 1 and 13.5 days ( 12 - 16 days ) in group 2 ( P < 0.05 ) . The Harris score of group 1 was 91.4 ( 67 - 94 ) and 78.5 ( 67 - 91 ) for group 2 at the 3 month follow-up ( P < 0.05 ) . At the last follow up , there were no significant difference ( P > 0.05 ) , but the average ROM of group 1 were definitely more greater than that of group 2 ( 110.0 degrees + /- 3.2 degrees vs. 90.0 degrees + /- 2.9 degrees P < 0.05 ) . There was 1 case of cup reinsertion in group 1 because of large anteversion angle ; 2 cases of symptomatic DVT and 1 case of lethargy because of cerebral infa rct ion happened in group 2 . CONCLUSIONS Minimally invasive total hip arthroplasty using anterior approach is a safe and effective technique with the advantages of less soft tissue damage and less blood loss Most systematic review s rely substantially on the assessment of the method ological quality of the individual trials . The aim of this study was to obtain consensus among experts about a set of generic core items for quality assessment of r and omized clinical trials ( RCTs ) . The invited participants were experts in the field of quality assessment of RCTs . The initial item pool contained all items from existing criteria lists . Subsequently , we reduced the number of items by using the Delphi consensus technique . Each Delphi round comprised a question naire , an analysis , and a feedback report . The feedback report included staff team decisions made on the basis of the analysis and their justification . A total of 33 international experts agreed to participate , of whom 21 completed all question naires . The initial item pool of 206 items was reduced to 9 items in three Delphi rounds . The final criteria list ( the Delphi list ) was satisfactory to all participants . It is a starting point on the way to a minimum reference st and ard for RCTs on many different research topics . This list is not intended to replace , but rather to be used alongside , existing criteria lists BACKGROUND Minimally invasive total hip arthroplasty is purported to allow an improved and faster rehabilitation in the immediate postoperative period because of reduced soft-tissue damage compared with total hip arthroplasty performed with use of a st and ard approach . In the present study , a minimally invasive approach was compared with a traditional st and ard approach in terms of the effect on gait kinematics as demonstrated with gait analysis and electromyography . METHODS Twenty r and omized patients who underwent a primary total hip replacement with use of a minimally invasive modified Watson-Jones approach ( minimally invasive group ) were compared with a group of twenty patients who underwent a total hip arthroplasty with use of a st and ard transgluteal Hardinge approach ( st and ard group ) . All patients received the same cementless implant , inserted with use of st and ard instruments , and all operations were performed by a single , experienced surgeon . The patients were evaluated with use of three-dimensional gait analysis and dynamic electromyograms at three time points : preoperatively , ten days postoperatively , and twelve weeks postoperatively . Temporospatial and joint-kinematic parameters were evaluated . RESULTS There were no significant differences between the two groups with regard to the temporospatial variables of velocity , cadence , step length , and stride length at any tested time point . With regard to the range of motion of the operatively treated hip , the minimally invasive group had a smaller decrease at the ten-day time point in comparison with the st and ard group . However , this finding was not significant . The reduction in the range of motion was mainly caused by reduced hip extension . A compensatory increase in the pelvic tilt was observed in both groups . One patient in the st and ard group showed a positive Trendelenburg gait ten days postoperatively ; it had disappeared completely at the twelve-week time point . CONCLUSIONS With regard to gait kinematics in the early postoperative period ( three months ) , the present study showed no significant benefit for patients who underwent a total hip arthroplasty through a minimally invasive Watson-Jones approach in comparison with those who were managed with a st and ard transgluteal approach Minimally invasive surgery has become a trend over the last few years in all aspects of orthopaedic surgery , including total hip arthroplasty . So-called mini-incision techniques involve limiting the length of the skin incision to 10 cm with use of either an anterior , lateral or posterior approach . Between March 2004 and December 2005 one hundred consecutive unilateral total hip replacements were performed by the same senior surgeon in our institute . All patients were r and omly assigned to study group ( group A ) or control group ( group B ) . In group A ( 50 patients ) the  skin incision was 8 cm ; in group B ( 50 patients ) the skin incision was st and ard ( about 12 - 14 cm ) . Patient demographic data , including sex , age , height , weight , BMI , diagnosis and preoperative Harris hip score were recorded . Other criteria evaluated included the perioperative and postoperative complications , the surgical time , the blood loss , the length of the incision , the acetabular and stem positions , the length of hospital stay , Harris Hip Score ( HHS ) and the WOMAC osteoarthritis index at six months . No significant differences were found between the groups with respect to the average surgical time , the acetabular and stem position , the length of hospital stay and the Harris Hip Score ( HHS ) and the WOMAC osteoarthritis index at six months . A significant lower blood loss was found in the mini-incision group . A higher percentage of peri-operative complications was recorded in Group A ( two stupor of sciatic nerve and one fracture of the greater trochanter ) . On the basis of our experience we could speculate that minimally invasive surgery should be directed to the new surgical approach with muscle sparing , instead of a shorter skin incision using st and ard approaches The purpose of this prospect i ve r and omized study was to compare the early results of primary total hip arthroplasties performed with a minimally invasive technique or a st and ard technique . A consecutive series of 70 patients who underwent primary bilateral simultaneous total hip arthroplasties was studied . All procedures were performed through a posterolateral approach . Operative times and duration of hemovac drains were significantly shorter in the group with a minimally invasive technique ( P < .05 ) . However , there was a risk of infection when using this technique . There were no any late transfusions in any of our patients postdischarge . This minimally invasive technique did not offer any advantages because the results were not different , and in our h and s , it increased our infection rate 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 The benefits of minimally invasive total hip arthroplasty continue to be debated . The objective of this study was to investigate the role of patient education , accelerated rehabilitation , and improved pain control on the outcome of  total hip arthroplasty  performed through a small incision . METHODS One hundred patients undergoing total hip arthroplasty at our institution were r and omized into one of four groups on the basis of the size of the incision , preoperative counseling , the type of preoperative and postoperative rehabilitation , and the analgesia protocol . The operative parameters , complications , time to discharge to home , functional improvement , and patient satisfaction were assessed . RESULTS The demographic distribution among the four groups was similar . The extent of functional improvement at the time of discharge to home , patient satisfaction , and walking ability at the time of discharge were better in patients who had received an accelerated preoperative and postoperative rehabilitation regimen regardless of the size of the incision . There was no difference in estimated blood loss , mean operative time , transfusion needs , or complications among the groups . CONCLUSIONS This study highlights the importance of factors such as family education , patient preconditioning , preemptive analgesia , and accelerated preoperative and postoperative rehabilitation in influencing the outcome of total hip arthroplasty . The aforementioned factors , and not the surgical technique per se , may play a major role in imparting the better outcome after minimally invasive total hip arthroplasty that has been reported by various investigators BACKGROUND The aim of this prospect i ve r and omized study was to compare the results after total hip replacement ( THR ) using an MIS approach  versus a regular transgluteal approach ( Bauer approach ) . METHOD We compared 20 THRs using a modified Watson-Jones minimally invasive approach ( MIS group ) with 20 conventionally performed THRs using a Bauer approach ( control group ) .  In all cases , the same implants ( Trilogy cup , MAYO stem ) were used . The Harris Hip Score ( HHS ) , the visual analogue scale , myoglobin level , and creatinine kinase level were measured preoperatively and up to 3 months postoperatively . RESULTS Advantages of the MIS group were evaluated using the HHS in the categories of activity and range of motion 6 weeks postoperatively . In terms of function , gait , and total HHS , we found benefits in the MIS group 6 and 12 weeks postoperatively . Up to 48 h postoperatively , patients in the MIS group had lower myoglobin blood levels . No differences were found in creatinine kinase levels , pain sensation as measured by visual analogue scale , or implant positioning . CONCLUSION Use of the minimally invasive Watson-Jones approach shows advantages compared with the transgluteal Bauer approach 6 and 12 weeks postoperatively . Up to now there has been no prospect i ve r and omized clinical study that has definitely shown the superiority of the minimally invasive procedure . For that reason , the conventional approaches in THR are still the gold st and ard Twenty patients who underwent total hip arthroplasty were r and omly allocated to have surgery through a mini incision of < or = 8 cm ( mini-incision surgery [ MIS ] group , n = 10 ) or a st and ard incision of 14 cm ( st and ard group , n = 10 ) . A laser Doppler flowmeter was used to measure the intraoperative blood flow of the skin . The measurements were performed at 2 regions , specifically , anterior and posterior regions across the middle points of skin incision . The measurements were taken before making the incision and after implantation . As a control , the skin blood flow over the anterior superior iliac spine was measured . After implantation , mean skin blood flows at both regions in the MIS group were significantly decreased by 32 % and 33 % . However , the corresponding flows in st and ard group and control regions were constant during operation
target: Compared with st and ard total hip replacement , mini-incision procedures may have small perioperative advantages in terms of less blood loss , shorter operative time , and shorter inpatient stay , but the differences were not clinical ly important .
  Few complications were reported , and the complication rate did not differ significantly between groups .
  There was insufficient evidence to suggest any major difference in the short-term revision rate , and confidence intervals for surrogate measures for long-term outcome were broad enough to include clinical ly important differences in favor of either approach .
  Although there were marginal short-term advantages and disadvantages for each of the surgical techniques , there was no strong evidence either for or against mini-incision compared with st and ard-incision total hip replacement .
  Importantly , evidence on longer-term performance , especially the risk of revision arthroplasty , for mini-incision hip arthroplasty is very limited
background: BACKGROUND Mini-incision total hip replacement continues the current trend in orthopaedics and other specialties toward smaller-incision surgery .
  The purpose of this systematic review was to assess the effectiveness and safety of single mini-incision compared with st and ard-incision total hip replacement for treatment of arthritis of the hip .