title: A prospective randomized peri- and post-operative comparison of the minimally invasive anterolateral approach versus the lateral approach.
abstract: There is still controversy as to whether minimally invasive total hip arthroplasty enhances the postoperative outcome. The aim of this study was to compare the outcome of patients who underwent total hip replacement through an anterolateral minimally invasive (MIS) or a conventional lateral approach (CON). We performed a randomized, prospective study of 75 patients with primary hip arthritis, who underwent hip replacement through the MIS (n=36) or CON (n=39) approach. The Western Ontario and McMaster Universities Osteoarthritis Index and Harris Hip score (HHS) were evaluated at frequent intervals during the early postoperative follow-up period and then after 3.5 years. Pain sensations were recorded. Serological and radiological analyses were performed. In the MIS group the patients had smaller skin incisions and there was a significantly lower rate of patients with a positive Trendelenburg sign after six weeks postoperatively. After six weeks the HHS was 6.85 points higher in the MIS group (P=0.045). But calculating the mean difference between the baseline and the six weeks HHS we evaluated no significant differences. Blood loss was greater and the duration of surgery was longer in the MIS group. The other parameters, especially after the twelfth week, did not differ significantly. Radiographs showed the inclination of the acetabular component to be significantly higher in the MIS group, but on average it was within the same permitted tolerance range as in the CON group. Both approaches are adequate for hip replacement. Given the data, there appears to be no significant long term advantage to the MIS approach, as described in this study.
authors.affiliation: Department of Orthopaedics, University of Duisburg-Essen Essen.
authors.forename: Stefan
authors.initials: S
authors.lastname: Landgraeber
authors.forename: Henning
authors.initials: H
authors.lastname: Quitmann
authors.forename: Sebastian
authors.initials: S
authors.lastname: Güth
authors.forename: Marcel
authors.initials: M
authors.lastname: Haversath
authors.forename: Wojciech
authors.initials: W
authors.lastname: Kowalczyk
authors.forename: Andrés
authors.initials: A
authors.lastname: Kecskeméthy
authors.forename: Hansjörg
authors.initials: H
authors.lastname: Heep
authors.forename: Marcus
authors.initials: M
authors.lastname: Jäger
keywords: hip approach; hip arthroplasty; minimally invasive