title: Is minimally invasive surgery less invasive in total hip replacement? A pilot study.
abstract: It has been suggested that minimally invasive surgery (MIS) in total hip replacement (THR) is less traumatic than standard techniques. This study was designed to address the question of whether an anterior MIS approach generates less inflammation and muscle damage than the standard posterolateral (PL) approach. Inflammation parameters such as interleukin-6 (IL-6), muscle damage parameters like heart type fatty acid binding protein (H-FABP), and haemoglobin (Hb) levels were determined pre-operatively and at five consecutive points post-operatively in 10 patients operated through a MIS anterior approach and in 10 patients operated through a PL approach. The mean IL-6 concentration increased from 3 pg/ml in both groups pre-operatively to 78.5 pg/ml (PL group) vs 74.8 pg/ml (MIS group) at 6 hours post-operatively and reached a maximum of 100 pg/ml (PL group) vs 90.5 pg/ml pg/ml (MIS group) after 24 hours. Up to this time point, there was a decrease in both groups. The post-operative mean H-FABP concentration increased to 10.7 microg/l in the PL group vs 15.8 microg/l in the MIS group. It formed a plateau and decreased after 24 hours post-operatively. The Hb levels were 14.5 g/dl before surgery and decreased to 10.7 g/dl (PL group) and 10.0 g/dl (MIS group) at 72 hours post-operatively. No significant differences were found between the two approaches either in inflammation and muscle damage or blood loss. Although the absence of a learning curve may explain the lack of a difference between both techniques, we speculate that the term MIS is at least doubtful in terms of being less traumatic.
authors.affiliation: Department of Orthopaedics, Reinier de Graaf Hospital, The Netherlands. Peter_pilot@hotmail.com
authors.forename: P
authors.initials: P
authors.lastname: Pilot
authors.forename: B
authors.initials: B
authors.lastname: Kerens
authors.forename: W F
authors.initials: WF
authors.lastname: Draijer
authors.forename: N P
authors.initials: NP
authors.lastname: Kort
authors.forename: J
authors.initials: J
authors.lastname: ten Kate
authors.forename: W A
authors.initials: WA
authors.lastname: Buurman
authors.forename: H
authors.initials: H
authors.lastname: Kuipers
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D005260:Female; D006801:Humans; D007249:Inflammation; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D018482:Muscle, Skeletal / Q000293:injuries; D011183:Postoperative Complications / Q000517:prevention & control*