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Mini-incision THA not recommended based on 10-year outcomes
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BELFAST, NORTHERN IRELAND — There were no differences in functional outcomes at a minimum follow-up of 10 years after total hip arthroplasty performed with either a minimal-incision or a standard-incision surgical technique, a presenter said at the British Orthopaedic Association Annual Congress, here.
“We do not recommend routine adoption of this technique,” Ciara Stevenson, MRCS, of Belfast, Northern Ireland, said.
She presented 10-year findings of a prospective, randomized controlled trial of minimal-incision total hip arthroplasty (THA) vs. standard-incision THA that her group conducted. The original study included 6-weeks follow-up and showed a smaller incision did not improve early THA outcomes over a standard incision. At long-term follow-up, the only difference was patients in the minimal-incision group had a smaller scar, Stevenson said.
For the investigation, Stevenson and colleagues recalled patients, all of whom were originally operated on by David Beverland, MD, FRCS, to the clinic. The investigators sought to determine the functional and radiological outcomes, including the presence of osteolysis, at a median of 124 months after primary THA. Of the 220 patients originally studied, 150 patients had outcome scores and 118 patients had radiographs at the latest follow-up. The groups were matched by age and American Society of Anesthesiologists grade, as well as with their preoperative BMI, according to study details.
“There was no significant difference in revision rate between groups,” Stevenson said.
According to Stevenson “In this series, minimally invasive hip surgery confers no benefit at 6 weeks or 10 years. But, this was in the hands of an experienced high-volume hip surgeon. He had surpassed the learning curve. Could this be said the same for the low-volume hip surgeon struggling to get access [this] technique in an increasingly obese population?”
Instead of focusing on the incision in THA, Stevenson’s group hopes surgeons will focus on proper component alignment and fixation, eliminating infection risk and other factors. – by Susan M. Rapp
References:
Stevenson C, et al. Paper #573. Presented at: British Orthopaedic Association Annual Congress; Sept. 13-16, 2016; Belfast, Northern Ireland.
Ogonda L, et al. J Bone Joint Surg Am. 2005;87:701-710.
Disclosure: Stevenson reports no relevant financial disclosures.