Elsevier

The Journal of Arthroplasty

Volume 29, Issue 10, October 2014, Pages 1970-1982
The Journal of Arthroplasty

A Systematic Review and Meta-Analysis of the Standard Versus Mini-Incision Posterior Approach to Total Hip Arthroplasty

https://doi.org/10.1016/j.arth.2014.05.021Get rights and content

Abstract

The mini-incision posterior approach may appeal to surgeons comfortable with the standard posterior approach to the hip. We present the first systematic review and meta-analysis of these two approaches. Twelve randomised controlled trials and four non-randomised trials comprising of 1498 total hip arthroplasties were included. The mini-incision posterior approach was associated with an early improvement in Harris hip score of 1.8 points (P < 0.001), reduced operating time (5 minutes, P < 0.001), length of hospital stay (14 hours, P < 0.001), intraoperative and total blood loss (63 ml, P < 0.001 and 119 ml, P < 0.001 respectively). There were no statistically significant differences in the incidence of dislocation, nerve injury, infection or venous thromboembolic events. The minimally invasive posterior approach appears to provide a safe and acceptable alternative to the standard incision posterior approach.

Section snippets

Materials and Methods

We conducted the systematic review and meta-analysis using methods described in the Cochrane Handbook for Systematic Reviews of Interventions [24] and in accordance with Preferred Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines [25]. The protocol for this systematic review is registered and available on the Prospero database CRD42013004943.

Results

Literature searches identified 941 articles and after screening in duplicate, 16 studies published between 2003 and 2014 were included in the review. An additional three records report different aspects of the same RCT 35., 36., 37., and have therefore been amalgamated to avoid duplication of data. Progress of articles through this review is summarised as a flow diagram in Fig. 1.

Discussion

This systematic review and meta-analysis is based on the highest quality evidence from RCTs and nRCTs, and broadly demonstrates clinical equivalence between the standard and mini-incision posterior approaches.

Several systematic reviews investigating minimally invasive or mini-incision surgery have been reported previously 48., 49.. These reviews group together all the different minimally invasive approaches making the findings too generalised. Our review specifically examines only the posterior

Acknowledgments

We are grateful for the assistance of study authors who contributed additional information to our systematic review and meta-analysis: David Farr, Jon Goosen and Young-Hoo Kim.

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    The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2014.05.021.

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