Total hip arthroplasty: minimally invasive surgery or not? Meta-analysis of clinical trials

Abstract

Background: There exist a relevant number of clinical trials comparing the minimally invasive surgery to the standard-invasive approach in total hip arthroplasty (THA). Up to date, there are still debates concerning the most effective approach in THA.

Aim: The purpose of this study is to compare the clinical outcomes concerning patients undergoing primary THA performed via the minimally invasive versus standard-invasive surgery incision.

Material and methods: The search was performed in the main databases, evaluating both quantitative and qualitative results. All the randomised controlled trials (RCTs) and non-randomised controlled trials (nRCTs) comparing the minimally invasive versus the standard-invasive approach were enrolled in this study. We focused on the clinical and radiological outcomes and on the complication rate. Study methodological quality was assessed performing the PEDro critical appraisal scale. All meta-analyses were performed using the Review Manager software. To analyse the publication's bias, we performed the Funnel plot.

Result: We enrolled in our study 4761 patients, undergoing to 4842 total hip arthroplasties. The mean follow-up was 22.26 months. In favour of the minimally invasive group, we reported less total estimated blood loss, shorter surgical duration, and a shorter length of stay. In favour of the standard-invasive group, we reported a higher value of the Harris hip score. Concerning the radiological outcomes, we did not report substantial differences across the two exposures. No difference was observed regarding the risk of femoral fractures, dislocation, and revision rates. We evidenced an increasing risk occurred in an iatrogenic nerve palsy during the minimally invasive approach.

Conclusion: Based on currently available evidences concerning the outcomes following THA and the analysis of our results, we stated no remarkable benefits of the minimally invasive compared to the standard-invasive surgery.

Keywords: Approach; Exposure; Hip prosthesis; Invasive; Mini; Minimally; Standard; Total hip arthroplasty; Total hip replacement; osteoarthritis.