Mini-incision technique for total hip arthroplasty with navigation

doi:10.1054/arth.2003.50025

The Journal of Arthroplasty

Volume 18, Issue 2, March 2003, Pages 123-128

https://doi.org/10.1054/arth.2003.50025 Get rights and content

Abstract

This prospective 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. Copyright 2003, Elsevier Science (USA). All rights reserved.

Section snippets

Materials and methods

The mini-incision surgical technique was first used for primary THA in October of 1998. One hundred twenty-one patients with 137 hips underwent surgery using this technique. Thirty-three patients (35 hips; group 1) were selected of 121 patients who had undergone a mini-incision THA matched by diagnosis, gender, average age, and preoperative Harris Hip Score (HHS) ^[13] to 33 patients (35 hips; group 2) of 120 patients who had undergone THA using the traditional posterior approach. The same

Surgical technique

The mini-incision surgical approach used in our study is a modification of the traditional posterior approach (Moore). However, the landmarks for initial skin incision varies significantly. Moore's incision starts approximately 10 cm distal to the posterior superior iliac spine and extendes distally and laterally parallel with the fibers of the gluteus maximus to the posterior margin of the greater trochanter. The traditional incision is then directed distally 10 to 13 cm parallel with the

Results

The average length of the skin incisions for group 2 (traditional posterior approach) measured 20.2 cm (range, 14.8–26.0). For group 1 (mini-incision), the skin incision averaged 11.7 cm (range, 7.3–13.0) (P<.001). The average surgical time was 2 hours for the mini-incision group and 1 hour and 40 minutes for the traditional approach. The preoperative plan for each cup position was 45° of abduction and 20° of flexion. Acetabular cup alignment for both groups was within 5° of the preoperatively

Discussion

We are aware of no clinical data in the literature comparing the functional results of mini-incision with those of the traditional posterior approach for THA with the navigation system. Wright, Crockett, and Sculco ^[21] described the minimal posterior approach for THA and found that primary THA in selected patients can be performed safely and effectively. The authors concluded that cup malposition is the most significant potential pitfall of a mini-incision technique, and recommended extending

References (24)

R Navarro et al.
Surgical approach and nerve palsy in total hip arthroplasty
J Arthroplasty
(1995)
A DiGioia et al.
Comparison of a mechanical acetabular alignment guide with computer placement of the socket
J Arthroplasty
(2002)
S Lie et al.
Mortality after total hip replacement: 0-10-year follow-up of 39.543 patients in the Norwegian Arthroplasty Regisrter
Acta Orthop Scand
(2000)
S Knutsson et al.
An evaluation of patients' quality of life before, 6 weeks and 6 months after total hip replacement surgery
J Advanced Nursing
(1999)
B Borghi et al.
Incidence and risk factors for allogenic blood transfusion during major joint replacement using an integrated autotransfusion regimen
Eur J Anaesthesiol
(2000)
B Bierbaum et al.
An analysis of blood management on patients having a total hip or knee arthroplasty
J Bone Joint Surg Am
(1999)
L Ahrengart et al.
Heterotopic bone after hip arthroplasty: defining the patient at risk
Clin Orthop Rel Res
(1993)
C Hierton et al.
Factors associated with heterotopic bone formation in cemented total hip prostheses
Acta Orthop Scand
(1983)
Riegler H, Harris C
Heterotopic bone formation after total hip arthroplasty: Clin Orthop Rel Res
(1976)
S Eggli et al.
Heterotopic ossification in total hip arthroplasty: the significance for clinical outcome
Acta Orthop Belg
(2000)

T Schmalzried et al.

Nerve palsy associated with total hip replacement

J Bone Joint Surg Am

(1991)

AM DiGioia et al.

Computer assisted orthopaedic surgery: image guided and robotic assistive technologies

Clin Orthop Rel Res

(1998)

Cited by (248)

Information loss challenges in surgical navigation systems: From information fusion to AI-based approaches
2023, Information Fusion
Surgical navigation technology provides minimally invasive surgery (MIS) with the relative pose relationships amongst medical images, surgical instruments, and lesions. On the other hand, traditional operation procedures depend heavily on direct surgical field exposure. Consequently, introducing surgical navigation can enable surgeons to operate more accurately and efficiently. A tracking system is a core enabling technology of a surgical navigation system. In this paper, after reviewing the tracking technologies, we compare and analyze their pros and cons, and find that information loss is a common challenge. The information loss problem is an inherent drawback in mono-modality surgical navigation systems. It is characterized by physical constraints, attenuation, breakdown of signal, and accuracy instability of the tracking algorithms. This review focuses on the information loss problem in tracking technologies for surgical navigation systems. Furthermore, we survey the existing solutions that aim at tackling the information loss problem, especially in the information fusion of surgical tracking technologies, and we also summarize their key improvements and limitations. Particular attention has been given to the modalities, approaches, objectives, and surgical application scenarios, which can improve the accuracy, precision, and stability of surgical navigation systems. Finally, future research trends directed at improving the information loss problem are discussed, i.e., tight integration of sensing technology, augmented reality for visualization in surgical tracking, stable high-speed 5G networks for telesurgery, strong intelligence and affordable service.
Anterior Percutaneous-Assisted Total Hip Arthroplasty: Surgical Technique and Early Outcomes
2020, Arthroplasty Today
Percutaneous-assisted arthroplasty was introduced to minimize complications traditionally associated with minimally invasive techniques, such as component malposition and periprosthetic fracture. Proponents of percutaneous-assisted techniques have more than 15 years of clinical utilization with good outcomes. This study reports our early experience, and outcomes, with an anterior percutaneous-assisted total hip arthroplasty (AnteriorPath).
A retrospective evaluation of a single-surgeon experience with the first 46 patients undergoing AnteriorPath using a cannula for acetabular cup instrumentation was compared with a similar-sized cohort undergoing traditional direct anterior (DA) total hip arthroplasty. Patients needed at least 2 postoperative visits for inclusion. Baseline preoperative characteristics, operative time, component positioning, and 6-week all-cause complications were evaluated. P values <.05 were considered statistically significant.
Longer operative times were experienced with the AnteriorPath vs DA THA (93.6 minutes ± 38.6 vs 79.6 minutes ± 23.2, respectively, P = .0503). There were no significant differences in component abduction (40.14° DA vs 41.95° AnteriorPath, P = .1058). A statistically significant difference was found in component anteversion (32.8° DA vs 27.25° AnteriorPath, P = .0039). There were higher rates of short-term complications in patients undergoing DA THA (9.09% DA vs 2.5% AnteriorPath).
Early experience with an AnteriorPath demonstrates similar short-term outcomes compared with traditional DA THA. The use of a percutaneous technique has also allowed for a smaller incision, in-line acetabular cup reaming and impaction under direct visualization, and limited trauma to surrounding soft tissues. Further long-term studies with a larger sample size are needed to evaluate the potential benefits and complications of this novel technique
Risk Factors for Nerve Injury After Total Hip Arthroplasty: A Case-Control Study
2019, Journal of Arthroplasty
Postsurgical acute nerve injury is rare but potentially devastating following total hip arthroplasty (THA). Previous literature suggests a wide range of incidence from 0.1% to 7.6%. Confirmed risk factors for these injuries remain unclear.
THA patients at our institution who developed nerve injury during their admission for THA between January 1, 1998, and December 31, 2013, were systematically identified and matched with 2 control subjects by surgical date. Relevant patient and surgical data were obtained through review of patient charts and electronic health records. We identified potential risk factors and calculated odds ratios (OR) using a conditional logistic regression model with a parsimonious stepwise approach.
We identified 93 nerve injuries in 43,761 THAs (0.21%). The mean age of cases was 63 years. Adjusting for other factors in the model, patients <45 years were found to be at increased risk of developing nerve injury (OR, 7.17; P = .033). Similarly, patients with a history of tobacco use (OR, 1.90; P = .030) and a history of spinal surgery or disease (OR, 10.06; P < .001) were also associated with increased risk of nerve injury. For every 30-minute increase in surgery time after 1 hour, risk of nerve injury risk increased (OR, 1.48; P = .034). Assignment as first operative case of the morning was associated with a decreased risk of nerve injury (OR, 0.37, P = .043).
This study demonstrates that nerve injury is a rare complication following THA at our institution. We found risk factors that are possibly modifiable factors such as lumbar spine disease, smoking, and time of surgical scheduling.
Is the Direct Superior, Iliotibial Band-Sparing Approach Associated With Decreased Pain After Total Hip Arthroplasty?
2017, Journal of Arthroplasty
Recently, the direct superior approach (DSA) has been introduced in total hip arthroplasty (THA) with the goal of limiting soft tissue dissection. This study's purpose was to use a visual pain diagram questionnaire to determine the location and severity of pain in patients undergoing THA via a DSA vs miniposterior approach (MPA).
This was a prospective, Institutional Review Board (IRB)-approved investigation from 3 centers. Patients aged 18-70 years with a diagnosis of osteoarthritis were included. Two centers used the MPA, while 1 center the DSA. The DSA uses a 9- to 12-cm incision with its distal extent at the posterosuperior greater trochanter. Dissection into the iliotibial band is avoided, and the capsule at the inferior femoral neck is preserved. All THAs in both cohorts received a cementless, titanium, proximally coated femoral stem and a hemispherical acetabular component.
A total of 42 DSA and 196 MPA THA patients were included. Overall, 43% of patients reported pain in at least 1 of the 8 anatomic areas assessed. There was no difference in the incidence of moderate to severe pain in any anatomic area of interest between the MPA and DSA cohorts (P = .1-.9). Specifically, the incidence of moderate to severe trochanter (17% MPA vs 17% DSA, P = .9), anterior thigh (15% MPA vs 17% DSA, P = .9), and lateral thigh pain (12% MPA vs 12% DSA, P = .9) was nearly identical in both cohorts.
This study was unable to demonstrate a difference in the incidence of residual pain after use of a DSA or an MPA approach after THA.
Risk of Periprosthetic Fractures With Direct Anterior Primary Total Hip Arthroplasty
2016, Journal of Arthroplasty
Despite increasing interest in the anterior approach for cementless, primary total hip arthroplasty (THA), studies examining the incidence of periprosthetic fractures with this approach are lacking. The purpose of this study was to (1) investigate the incidence of early periprosthetic fractures associated with primary THA performed through an anterior supine intermuscular (ASI) approach without the use of a specialized table and (2) identify potential risk factors for these fractures.
We identified 2869 primary THAs performed via the ASI approach using a single cementless, tapered titanium femoral component with short and standard length options between February 2007 and April 2014. Fifty-two percent of THAs were in female patients, whereas 48% were in males. Short stems were used in 59% vs standard length in 41%.
There were 26 (0.9%) early periprosthetic femoral fractures, with 23 requiring revision. When looking at the potential risk factors of age, gender, body mass index, and stem length, the only significant finding was that increased age was associated with increased risk of femoral fracture. Logistic regression analysis revealed a significant age-fracture association for female gender only, which remained when controlled for body mass index, stem length, or both.
The muscle-sparing ASI approach appears to be a safe technique for performing primary THA when used in a suitable patient population. The early periprosthetic femoral fracture rate in our series may warrant consideration of using a different design or different approach in elderly female patients.
Conventional versus minimally invasive total hip replacement through the posterior approach
2020, Journal of Arthroscopy and Joint Surgery
The rationale for minimally invasive surgery (MIS) is to minimize tissue damage in order to reduce blood loss, decrease postoperative pain, shorten hospital stay, and allow for faster rehabilitation. Objectives This study compares the short-term clinical and radiographic outcome between conventional and minimally invasive posterior approaches in total hip arthroplasty. Study Design & Methods We conducted a prospective, comparative pilot study containing 30 patients who underwent primary total hip arthroplasty between January 2017 and May 2017, 15 of them were operated through a conventional posterior approach and the other 15 were operated upon using a minimally invasive posterior approach. The exclusion criteria were severe protrusio or acetabular dysplasia as well as severe obesity (more than 120 kg body weight or a body mass index (BMI) > 40). For all patients, age, gender, indication, body mass index (BMI), preoperative hemoglobin and preoperative assessment using radiology, WOMAC and Harris hip scores were recorded. The patients were informed about the type of their operation. Results:There was a significant difference in the mean operative time (p < 0.001),rehabilitation and early return to workand usual activities (p < 0.001) in favour of the minimally invasive approach. Furthermore, there was no need for blood transfusion in the MIS group compared to 20% in the conventional group, better cosmetic results in the MIS group (mean scar length was 9.07 compared to 21.67 in the conventional approach) and more incidence of complications with the conventional approach (13.33% as compared to 0% in the MIS group). These differences were statistically highly significant (p < 0.0001). No significant differences were seen as regards the clinical outcome at 6 months post-operative (using the WOMAC and Harris hip scores) and the radiological results between in both groups. Conclusions:The minimally invasive posterior approach allows reduced blood loss, reduced operative time, decreased incidence of blood transfusion, faster rehabilitation and earlier return to workin total hip arthroplasty.

View all citing articles on Scopus

^*: No benefits or funds were received in support of this study.

^**: Reprint requests: Anthony M. DiGioia III, MD, Institute for Computer Assisted Orthopaedic Surgery, The Western Pennsylvania Hospital, Mellon Pavilion, Suite 242, 4815 Liberty Avenue, Pittsburgh, PA 15242.

View full text

Original ArticlesMini-incision technique for total hip arthroplasty with navigation*,**

Abstract

Section snippets

Materials and methods

Surgical technique

Results

Discussion

J Arthroplasty

J Arthroplasty

Mortality after total hip replacement: 0-10-year follow-up of 39.543 patients in the Norwegian Arthroplasty Regisrter

Acta Orthop Scand

An evaluation of patients' quality of life before, 6 weeks and 6 months after total hip replacement surgery

J Advanced Nursing

Incidence and risk factors for allogenic blood transfusion during major joint replacement using an integrated autotransfusion regimen

Eur J Anaesthesiol

An analysis of blood management on patients having a total hip or knee arthroplasty

J Bone Joint Surg Am

Heterotopic bone after hip arthroplasty: defining the patient at risk

Clin Orthop Rel Res

Factors associated with heterotopic bone formation in cemented total hip prostheses

Acta Orthop Scand

Riegler H, Harris C

Heterotopic bone formation after total hip arthroplasty: Clin Orthop Rel Res

Heterotopic ossification in total hip arthroplasty: the significance for clinical outcome

Acta Orthop Belg

Nerve palsy associated with total hip replacement

J Bone Joint Surg Am

Computer assisted orthopaedic surgery: image guided and robotic assistive technologies

Clin Orthop Rel Res

Original Articles
Mini-incision technique for total hip arthroplasty with navigation*,**