Full Article
Evidence Summary
What is an Evidence Summary?
Key messages from scientific research that's ready to be acted on
Got It, Hide thisMini-incision and standard posterior incision surgery for hip replacement have similar benefits and safety
Berstock JR, Blom AW, Beswick AD A systematic review and meta-analysis of the standard versus mini-incision posterior approach to total hip arthroplasty. J Arthroplasty. 2014;29:1970-82.
Review question
In people having total hip replacement surgery (arthroplasty), how does mini-incision surgery compare with standard posterior incision surgery?
Background
People who have degenerative hip disease, like osteoarthritis, often go on to total hip replacement surgery when all non-surgical treatments have been tried. Hip replacement surgery has good long-term outcomes. Newer, minimally invasive approaches use shorter incisions and potentially have less of an effect on soft tissues (such as muscle) when done by experienced surgeons, and might lead to faster recovery. Surgeons can access the hip joint from the front (anterior), the side (lateral) or the buttock (posterior).
How the review was done
The researchers did a systematic review searching for published studies up to January 2014. They found 16 studies, including 12 randomized controlled trials, with 1424 people (1498 hips were operated on).
In the studies, people were having hip replacement for degenerative hip disease (osteoarthritis). Average age was over 60 years.
Mini-incision (approximately 10 cm or shorter) posterior surgery was compared with standard-incision posterior surgery.
People were followed for between 1.5 months and an average of 5 years.
Outcomes included dislocation of the replaced joint, length of hospital stay after surgery, the Harris hip score (which measures pain, function, deformity, and range of motion), and the WOMAC score (which measures pain, stiffness, and function of the joints).
What the researchers found
The randomized controlled trials were of high quality, and the nonrandomized studies were of medium quality.
People who had mini-incision surgery had shorter hospital stays (0.5 days shorter) and less blood loss than people who had standard incision surgery. For total hip replacements done through a posterior approach, mini-incision and standard incision surgery did not differ for complications from surgery, such as joint dislocations, nerve injury, infections, or clots. They also did not result in important differences in pain and functioning (as measured by the Harris Hip Score or WOMAC score).
Conclusion
In people having hip replacement surgery done with a posterior approach, mini-incision surgery is an effective and safe alternative to standard incision surgery when considering patient-important outcomes.
Mini-incision vs standard incision posterior hip replacement surgery
| Outcomes | Number of studies (number of hips) | Mini-incision surgery | Standard incision surgery | Effect of min-incision surgery |
| Dislocation | 13 studies (1198 hips) | 1.2% | 1.0% | No difference in effect* |
| Length of hospital stay | 8 studies (925 hips) | An average of 2.6 days | An average of 3.1 days | About half a day less |
| Operating time | 14 studies (1386 hips) |
|
| About 4 minutes less |
| Blood loss during surgery | 10 studies (1177 hips) |
|
| About 82 mL (a third of a cup) less blood lost |
| Total blood loss | 3 studies (220 hips) |
|
| About 119 mL (half a cup) less blood lost |
Related Topics
Glossary
Studies where people are assigned to one of the treatments purely by chance.
A comprehensive evaluation of the available research evidence on a particular topic.
Related Evidence Summaries
-
Nutritional strategies can improve body composition in underweight and overweight older adults
JBI Database of Systematic Reviews and Implementation Reports (2016)
-
Exercise alone, and in combination with different fall prevention strategies may lower the risk of falls leading to injuries in older adults 65 and over
JAMA: Journal of the American Medical Association (2017)
-
Innovative hip and knee replacement devices do not improve function more than conventional devices and may increase need for revision surgery
BMJ (2014)
