Effectiveness of Minimally Invasive Surgery for Total Hip Arthroplasty: A Review of Literature

Background: Total hip arthroplasty (THA) is one of the most successful orthopedic procedures of the past three decades. In general, it relieves pain, improves function and especially quality of life of patients with degenerative or inflammatory pathology of the hip. The introduction of minimally invasive techniques for total hip replacement has generated further discussion about its benefits and risks in this field.

Objectives: Our literature review is a systematic compilation of published information related to minimally invasive surgery (MIS) for total hip arthroplasty. The main objective of this review is to determine the effectiveness of total hip arthroplasty with MIS compare to the traditional approach. Specifically, this appraisal aims to answer questions related to functionality, quality of life, and clinical results.

Methods: The bibliographic review was conducted in two phases: an initial phase of search for appropriate studies and a second phase of selection according to previously established criteria. The search for articles was carried out in major databases and subsequently in bibliographical references for the studies found. The databases reviewed were MEDLINE/PubMed/MeSH Database, EMBASE, Economic Evaluation Database/DARE/HTA, CSIC/EMI-Biomedicine, and ScienceDirect Collection. The search period was limited to the years 2003 to 2009. The selection of items was made at an early stage by screening article summaries followed by full texts.

Results: We initially selected 65 studies, 48 for detailed evaluation, and 27 final studies for inclusion in the review. The results of this review are presented in two sections. The first represents the main descriptive characteristics of the studies selected in favor of MIS (19), and the second presents the unfavorable studies (8). Among the main benefits we found a decrease of transfusion requirements, better mobilization and rehabilitation, low dislocation, reduced surgical time, shorter hospital stays, less soft tissue damage, and better short term results. The main drawbacks were increased risks of complications, malposition of prosthesis, healing problems, and irrelevant clinical incision size and functionality.

Conclusions: The studies presented in this review show clear evidence of how MIS influences the effectiveness related to functional outcomes, hospital stays, and surgical aggressiveness of the intervention. In this regard, we found a greater number of comparable studies supporting minimally invasive surgery in terms of effectiveness than those that emphasize complications and disadvantages of this technique.