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Meta-Analysis
. 2013 Apr;471(4):1283-94.
doi: 10.1007/s11999-012-2717-5. Epub 2012 Dec 11.

Is limited incision better than standard total hip arthroplasty? A meta-analysis

Joseph T Moskal  1 , Susan G Capps
Affiliations
Meta-Analysis

Is limited incision better than standard total hip arthroplasty? A meta-analysis

Joseph T Moskal et al. Clin Orthop Relat Res. 2013 Apr.

Abstract

Background: The literature comparing limited incision and standard incision THAs is confusing regarding whether limited incision THA improves short-term recovery without compromising long-term durability and survival. Further, previously published meta-analyses cannot conclude that limited incision THA is better. With new data, we seek to discover if the answers now exist.

Purpose: We used meta-analysis to compare surgical and hospitalization data, clinical outcomes, and complication rates, and thus (1) confirm whether limited incision THA is at least comparable to standard incision THA; and (2) determine whether limited incision THA is an improvement over standard incision THA.

Methods: The PubMed database was searched using the terms "minimally", "invasive", and "total hip". Inclusion was limited to studies directly comparing limited incision with standard incision THA and reporting effect sizes.

Results: We identified 418 articles. Of these 11 provided background information and 30 provided data (3548 THAs) for the systematic review. Limited incision THA was better than standard incision THA in four measures: length of hospitalization (6 versus 7 days), VAS pain at discharge (2 versus 4), blood loss (421 mL versus 494 mL), and the Harris hip score at 3 months postoperation (90 versus 84). There were no outcomes for which standard incision was better. There was no major difference in the rate of complications.

Conclusions: Short-term recovery favors limited incision over standard incision THA. The lack of consistent reporting for surgical outcomes, clinical outcomes, and complications continues to create difficulties when comparing limited and standard incision THAs.

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Figures

Fig. 1
Fig. 1
This flow diagram illustrates the number of articles selected from PubMed searches and the number remaining after the exclusion criteria were applied. LITHA = limited incision THA; SITHA = standard incision THA.
Fig. 2
Fig. 2
BMI is illustrated by a forest plot of pooled standard differences in means. Std diff = standard difference; *Peck et al. [40] dataset 1; †Peck et al. [40] dataset 2; LITHA = limited incision THA; SITHA = standard incision THA.
Fig. 3
Fig. 3
Length of hospitalization is illustrated by a forest plot of pooled standard differences in means. Std diff = standard difference; *Peck et al. [40] dataset 1; †Peck et al. [40] dataset 2; LITHA = limited incision THA; SITHA = standard incision THA.
Fig. 4
Fig. 4
VAS pain is illustrated by a forest plot of pooled standard differences in means. Std diff = standard difference; LITHA = limited incision THA; SITHA = standard incision THA.
Fig. 5
Fig. 5
Blood loss is illustrated by a forest plot of pooled standard differences in means. Std diff = standard difference; LITHA = limited incision THA; SITHA = standard incision THA.
Fig. 6
Fig. 6
Harris hip scores are illustrated by a forest plot of pooled standard differences in means for the 3-month followup. Std diff = standard difference; LITHA = limited incision THA; SITHA = standard incision THA.
See this image and copyright information in PMC

Comment in

References

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