S'abonner

Prospective and comparative study of minimally invasive posterior approach versus standard posterior approach in total hip replacement - 27/03/08

Doi : rce-03-2007-93-3-0035-1040-101019-200520000 

J.-M. Laffosse [1],

P. Chiron [1],

J.-L. Tricoire [1],

G. Giordano [1],

F. Molinier [1],

J. Puget [1]

Voir les affiliations

Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.

Connectez-vous pour en bénéficier!

Purpose of the study

There have been few prospective studies comparing minimally invasive approaches for total hip replacement. We sought to ascertain the contribution of the minimally invasive posterior approach in comparison with the standard posterolateral approach in terms of early outcome.

Materials and methods

This study investigated a prospective, comparative, consecutive series of patients. Patients with major architectural problems or undergoing revision arthroplasty were excluded. One hundred ten patients (116 hips) were divided into two groups that were comparable for the number of patients, gender, age, body mass index, indication for surgery, and preoperative function scores. The preoperative ASA score was lower in the minimally invasive group (= 0.04). The patients were in the lateral reclining position for both approaches and classical instrumentation using the same implants (stems and cemented or noncemented cups) was used. We noted operative time and blood loss (using the Brecher method based on the hematocrit count at day 1 and 5 and the number of blood transfusions), postoperative pain, and implant position. Functional outcome was assessed with the modified Harris Hip Score and the WOMAC index (at 6 weeks and 3 and 6 months). Statview® was used to search for statistical significance, considering p < 0.05 as significant.

Results

The mean length of the incision was 8.5 cm versus 15.1 cm. The mean blood loss was significantly less in the minimally invasive group (p = 0.027), as was the level of postoperative pain as confirmed by the lower consumption of morphine analgesics (= 0.006). Other operative variables as well as implant position were comparable. There were no major complications in the minimally invasive group. In the standard group, there was one case of common peroneal nerve palsy, two dislocations, and two fractures related to falls after prosthesis implantation. The WOMAC index score was higher after the minimally invasive approach at 6 weeks and at 3 months (p < 0.05). The modified Harris Hip Score was higher only at 6 weeks. Functional outcome and pain became comparable thereafter.

Discussion and conclusion

The minimally invasive posterior approach does not require an orthopedic table or specific instrumentation. A meticulous procedure is required with ligature of the posteromedial circumflex artery of the thigh to improve exposure and limit intraoperative bleeding. It enables satisfactory, reproducible implant positioning. Conversion to an open posterolateral approach is possible if needed. The minimally invasive posterior approach reduces intraoperative bleeding and postoperative pain with earlier and more rapid rehabilitation. The early clinical outcome is better, but beyond 6 weeks, the functional results are comparable for the two approaches. The minimally invasive posterior approach is a reliable, reproducible approach with a progressive learning curve.

Keywords: Posterior approach , minimally invasive surgery , total hip arthroplasty , prospective study , comparative


Plan



© 2007 Elsevier Masson SAS. Tous droits réservés.
Ajouter à ma bibliothèque Retirer de ma bibliothèque Imprimer
Export

    Export citations

  • Fichier

  • Contenu

Vol 93 - N° 3

P. 228-237 - mai 2007 Retour au numéro
Article précédent Article précédent
  • Arthroplastie totale de hanche chez l'insuffisant rénal chronique greffé ou dialysé
  • R. Debarge, V. Pibarot, O. Guyen, G. Vaz, JP. Carret, J. Bejui-Hugues
| Article suivant Article suivant
  • Computer-assisted surgery for acetabular cup positioning in total hip arthroplasty: comparative prospective randomized study
  • S. Parratte, J.-N. Argenson, X. Flecher, J.-M. Aubaniac

Bienvenue sur EM-consulte, la référence des professionnels de santé.

Mon compte


Plateformes Elsevier Masson

Déclaration CNIL

EM-CONSULTE.COM est déclaré à la CNIL, déclaration n° 1286925.

En application de la loi nº78-17 du 6 janvier 1978 relative à l'informatique, aux fichiers et aux libertés, vous disposez des droits d'opposition (art.26 de la loi), d'accès (art.34 à 38 de la loi), et de rectification (art.36 de la loi) des données vous concernant. Ainsi, vous pouvez exiger que soient rectifiées, complétées, clarifiées, mises à jour ou effacées les informations vous concernant qui sont inexactes, incomplètes, équivoques, périmées ou dont la collecte ou l'utilisation ou la conservation est interdite.
Les informations personnelles concernant les visiteurs de notre site, y compris leur identité, sont confidentielles.
Le responsable du site s'engage sur l'honneur à respecter les conditions légales de confidentialité applicables en France et à ne pas divulguer ces informations à des tiers.


Tout le contenu de ce site: Copyright © 2024 Elsevier, ses concédants de licence et ses contributeurs. Tout les droits sont réservés, y compris ceux relatifs à l'exploration de textes et de données, a la formation en IA et aux technologies similaires. Pour tout contenu en libre accès, les conditions de licence Creative Commons s'appliquent.