Chonnam Med J.  2014 Apr;50(1):15-20. 10.4068/cmj.2014.50.1.15.

Comparison of the Outcome in Bilateral Staged Total Hip Arthroplasty: Modified Two-Incision Minimally Invasive Technique versus the Conventional Posterolateral Approach

• Tumin M
• Park KS
• Abbas AA
• Yoon TR

• KMID: 1889757
• DOI: http://doi.org/10.4068/cmj.2014.50.1.15

Abstract

This retrospective study was undertaken to compare the outcomes of staged bilateral total hip arthroplasty (THA) by the conventional approach with those of two-incision minimally invasive (MIS-2) THA in terms of clinical and radiological results, complications, and patient preferences. Twenty-two patients aged 30 to 80 years underwent staged bilateral THA. The conventional posterolateral approach was used on the first hips treated and a modified MIS-2 approach on the second hips. The mean time between the first and second procedures was 73.8 months, and the patients were followed up for at least 12 months after both procedures. At the last follow-up visits, THA via the MIS-2 approach was found to provide significantly earlier partial-weight-bearing ambulation, better postoperative Harris hip scores, and better ability to sit cross-legged and was found to be more preferred by patients than conventional THA. There were no significant differences in the complication rates for the two approaches. The present results show that MIS-2 THA is as safe as the conventional posterolateral approach in experienced hands and presents no additional complication risks.

Keyword

Arthroplasty; Hip; Risk

MeSH Terms

Arthroplasty
Arthroplasty, Replacement, Hip*
Follow-Up Studies
Hand
Hip
Humans
Patient Preference
Retrospective Studies
Walking

Figure

• 

  FIG. 1 Diagram illustrating the incisions of total hip arthroplasty in the lateral position. (A) Conventional posterolateral approach and (B) modified two-incision minimally invasive approach.

Reference

1. Berger RA. Mini-incisions: two for the price of one! Orthopedics. 2002; 25:472. 498.

2. Berger RA. Minimally invasive total hip arthroplasty with two incisions. Oper Tech Orthop. 2006; 16:102–111.

3. Bal BS, Haltom D, Aleto T, Barrett M. Early complications of primary total hip replacement performed with a two-incision minimally invasive technique. J Bone Joint Surg Am. 2005; 87:2432–2438.

4. Duwelius PJ, Berger RA, Hartzband MA, Mears DC. Two-incision minimally invasive total hip arthroplasty: Operative technique and early results from four centers. J Bone Joint Surg Am. 2003; 85:2240.

5. Berry DJ, Berger RA, Callaghan JJ, Dorr LD, Duwelius PJ, Hartzband MA, et al. Minimally invasive total hip arthroplasty. Development, early results, and a critical analysis. Presented at the Annual Meeting of the American Orthopaedic Association, Charleston, South Carolina, USA, June 14, 2003. J Bone Joint Surg Am. 2003; 85:2235–2246.

6. Mardones R, Pagnano MW, Nemanich JP, Trousdale RT. The Frank Stinchfield Award: muscle damage after total hip arthroplasty done with the two-incision and mini-posterior techniques. Clin Orthop Relat Res. 2005; 441:63–67.

7. Archibeck MJ, White RE Jr. Learning curve for the two-incision total hip replacement. Clin Orthop Relat Res. 2004; (429):232–238.

8. Yoon TR, Bae BH, Choi MS. A modified two-incision minimally invasive total hip arthroplasty: technique and short-term results. Hip Int. 2006; 16:Suppl 4. 28–34.

9. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969; 51:737–755.

10. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988; 15:1833–1840.

11. Jando VT, Duncan CP. Two-incision technique for minimally invasive total hip arthroplasty. Oper Tech Orthop. 2004; 14:102–110.

12. Bostrom MP, Demetrakopoulos D, Reinhart J, Sculco TP. Minimally invasive posterior approach to total hip replacement. Curr Opin Orthop. 2005; 16:2–4.

13. Ogonda L, Wilson R, Archbold P, Lawlor M, Humphreys P, O'Brien S, et al. A minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes. A prospective, randomized, controlled trial. J Bone Joint Surg Am. 2005; 87:701–710.

14. Chimento GF, Sculco TP. Minimally invasive total hip arthroplasty. Oper Tech Orthop. 2011; 11:270–273.

15. Wenz JF, Gurkan I, Jibodh SR. Mini-incision total hip arthroplasty: a comparative assessment of perioperative outcomes. Orthopedics. 2002; 25:1031–1043.

16. Berger RA, Jacobs JJ, Meneghini RM, Della Valle C, Paprosky W, Rosenberg AG. Rapid rehabilitation and recovery with minimally invasive total hip arthroplasty. Clin Orthop Relat Res. 2004; (429):239–247.

17. Lawlor M, Humphreys P, Morrow E, Ogonda L, Bennett D, Elliott D, et al. Comparison of early postoperative functional levels following total hip replacement using minimally invasive versus standard incisions. A prospective randomized blinded trial. Clin Rehabil. 2005; 19:465–474.

18. Khan RJ, Fick D, Khoo P, Yao F, Nivbrant B, Wood D. Less invasive total hip arthroplasty: description of a new technique. J Arthroplasty. 2006; 21:1038–1046.

19. Kim YH. Comparison of primary total hip arthroplasties performed with a minimally invasive technique or a standard technique: a prospective and randomized study. J Arthroplasty. 2006; 21:1092–1098.

20. Pagnano MW, Leone J, Lewallen DG, Hanssen AD. Two-incision THA had modest outcomes and some substantial complications. Clin Orthop Relat Res. 2005; 441:86–90.

21. Bhan S, Pankaj A, Malhotra R. One- or two-stage bilateral total hip arthroplasty: a prospective, randomised, controlled study in an Asian population. J Bone Joint Surg Br. 2006; 88:298–303.