This article is more than 5 years old. Information may no longer be current.

Few advantages of minimally invasive THR, TKR seen vs. conventional arthroplasty

Add topic to email alerts

Receive an email when new articles are posted on

Please provide your email address to receive an email when new articles are posted on .

Subscribe

Added to email alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

Back to Healio

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Back to Healio

BERLIN — The advantages of minimally invasive surgery for total hip and knee replacement do not outweigh its high complication rates, according to results of a literature review presented here.

John M. Lloyd, FRCS, of Bournemouth, United Kingdom, presented the findings at the 13th EFORT Congress 2012, noting he and colleagues aimed to determine whether minimally invasive surgery (MIS) enhances recovery after total hip replacement (THR) and total knee replacement (TKR).

The investigators searched the literature on the subject using MEDLINE and PubMed databases, including case series, randomized controlled trials and systematic reviews, to determine the outcomes when MIS was used in THR or TKR. They defined MIS surgery as incisions less than 10 cm in the hip and less than 14 cm in the knee.

The improvement in recovery with MIS for THR and TKR is multi-factorial and when combined with improved anesthetic and rapid rehabilitation pathways the procedures result in enhanced recovery, Lloyd said. However, he noted only a little data indicated that MIS alone made a significant difference.

“If we look at length of stay, there were very few randomized controlled trials investigating this but it was very clear from the evidence available that there are benefits for unicompartmental knee replacement (UKR),” Lloyd said. “However, if we hone down to total knee replacement, there does not appear to be any clear advantage.”

Complication rates of MIS associated with low- to medium-volume surgeons appear unacceptably high compared to more traditional approaches, Lloyd said.

“Purely in isolation, [MIS] does not appear to reduce the length of hospital stay,” Lloyd said. “And yes, there do appear to be higher complication rates. I think only time will tell whether these small benefits are at the expense of long-term implant survival.”

“[MIS] offers marginal benefits in total hip and knee replacement recovery, but for the average user, like myself, I think any benefit would clearly be overshadowed by an unacceptably high complication rate,” he added. “We therefore conclude, with the exception of [UKR], it should not be part of a fast track hip and knee pathway.”

Reference:

Lloyd J, Wainwright T, Middleton R. Enhanced recovery in hip and knee arthroplasty: The role of minimally invasive surgery. Paper #12-1244. Presented at the 13th EFORT Congress 2012. May 23-25. Berlin.

Disclosures: Lloyd and colleagues reported no relevant financial disclosures.