Early Pain Relief and Function After Posterior Minimally Invasive and Conventional Total Hip Arthroplasty

Dorr, Lawrence D.; Maheshwari, Aditya V.; Long, William T.; Zhinian Wan; Sirianni, Leigh Ellen
June 2007
Journal of Bone & Joint Surgery, American Volume;Jun2007, Vol. 89-A Issue 6, p1153
Academic Journal
Background: Few prospective randomized studies have demonstrated benefits of minimally invasive total hip arthroplasty when compared with conventional total hip arthroplasty. We hypothesized that patients treated with a posterior mini-incision would have better results than those treated with a posterior long incision with regard to the achievement of established goals for pain relief and functional recovery permitting hospital discharge by the second postoperative day. Methods: Sixty of 231 eligible patients were randomized (with thirty in each group) to have a total hip arthroplasty performed through either a posterior mini-incision (10 ± 2 cm) or a traditional long incision (20 ± 2 cm). After completion of the total hip arthroplasty, the mini-incision group underwent extension of the skin incision to 20 cm. Patients were evaluated on the basis of self-determined pain scores, requirements for pain medicine, need for assistive gait devices, and time until discharge. Gait analysis provided objective functional assessment. Results: The average hospital stay was 63.2 ± 13.3 hours in the mini-incision group and 73.6 ± 23.5 hours in the long-incision group (p = 0.04). More patients with a mini-incision were discharged by the second postoperative day (p = 0.003) and more were using just a single assistive device at the time of discharge (p = 0.005). As scored on a verbal analog scale of 0 to 10 points, patients with a mini-incision had less pain on each postoperative day and the pain score remained significantly lower at the time of discharge (mean, 2.2 ± 1.0 points compared with 3.1 ± 0.9 points in the long-incision group; p = 0.002). After hospital discharge, there were no clinical differences in pain or function between the two groups of patients. Conclusions: Compared with conventional total hip arthroplasty performed through a posterior incision, posterior minimally invasive total hip arthroplasty resulted in better early pain control, earlier discharge to home, and less use of assistive devices. Subsequent evaluations at six weeks and three months showed equivalency between the clinical results in the two groups. Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • CLINICAL PERFORMANCE OF A DURASUL HIGHLY CROSS-LINKED POLYETHYLENE ACETABULAR LINER FOR TOTAL HIP ARTHROPLASTY AT FIVE YEARS. Dorr, Lawrence D.; Zhinian Wan; Shahrdar, Cambize; Sirianni, Leighellen; Boutary, Myriam; Yun, Andrew // Journal of Bone & Joint Surgery, American Volume;Aug2005, Vol. 87-A Issue 8, p1816 

    Background: Highly cross-linked polyethylene is currently the most common articulation surface used for total hip arthroplasty. The hypothesis of the present study was that the Durasul highly cross-linked polyethylene acetabular liner would have less wear at five years than would a conventional...

  • REVISION OF THE ACETABULAR COMPONENT WITHOUT CEMENT AFTER TOTAL HIP ARTHROPLASTY. Della Valle, Craig J.; Shuaipaj, Tasin; Berger, Richard A.; Rosenberg, Aaron G.; Shott, Susan; Jacobs, Joshua J.; Galante, Jorge O. // Journal of Bone & Joint Surgery, American Volume;Aug2005, Vol. 87-A Issue 8, p1795 

    Abstract: We previously reported our results at a minimum of three and seven years after use of a porous-coated acetabular metal shell in a consecutive series of 138 revision total hip arthroplasties. The current report presents the longer-term outcomes of these procedures, at fifteen to...

  • Usefulness of Histological Analysis for Predicting the Presence of Microorganisms at the Time of Reimplantation After Hip Resection Arthroplasty for the Treatment of Infection. Bori, Guillem; Soriano, Alex; Garcia, Sebastian; Mallofré, Carme; Riba, Josep; Mensa, Josep // Journal of Bone & Joint Surgery, American Volume;Jun2007, Vol. 89-A Issue 6, p1232 

    Background: Appropriate interpretation of a frozen section has a relatively high specificity and sensitivity for the diagnosis of infection when septic loosening of a prosthesis is suspected. However, its usefulness for predicting the presence of microorganisms at the time of reimplantation...

  • Relationship between Patterns of Putting-on and Taking-off Socks and Hip Flexion Range of Motion in Early Stages after Total Hip Arthroplasty Surgery. Nankaku, Manabu; Takagi, Aya; Akiyama, Haruhiko; Goto, Koji; Nakamura, Takashi; Kakinoki, Ryosuke // Rigakuryoho Kagaku;2009, Vol. 24 Issue 2, p241 

    [Purpose] The purpose of this study was to investigate the relationship between patterns of putting-on and taking-off socks and flexion range of total arthroplastic hips in the early postoperative period. [Subjects] The subjects of this study were 74 patients (81 hip joints) who had undergone...

  • Total hip arthroplasty using an uncemented femoral component with taper design: outcome at 10-year follow-up. Schramm, M.; Keck, F.; Hohmann, D.; Pitto, R. P. // Archives of Orthopaedic & Trauma Surgery;Jul2000, Vol. 120 Issue 7/8, p407 

    The aim of this study was to assess the clinical and radiological outcome of the cementless-system (CLS) femoral component designed by Spotorno with a taper design. Ninety-four patients (107 hips) were operated on from January 1987 to December 1988. The female/male ratio was 2/1, the mean age...

  • Michael Mont on Metal-On-Metal Hip Resurfacing Arthroplasty. Mont, Michael A. // Orthopedics;Oct2004, Vol. 27 Issue 10, p1047 

    The article presents an interview with physician Michael A. Mont about metal-on-metal total hip arthroplasty (THA). Mont discusses the status of the use of metal-on-metal THA in 2004. The level of difficulty of performing metal-on-metal THA compared to conventional THA is assessed. He also...

  • The initial fixation of the press-fit acetabular shell – clinical observation and experimental study. Kaneko, Kazuo; Inoue, Yukio; Yanagihara, Yasushi; Uta, Souichi; Mogami, Atsuhiko; Iwase, Hideaki // Archives of Orthopaedic & Trauma Surgery;May2000, Vol. 120 Issue 5/6, p323 

    The initial solid fixation of an uncemented acetabular component affects the amount of bone ingrowth. We had several problems with broken screws in cases of acetabular revision. In recent years, the development of uncemented components without screws has attempted to improve these problems. We...

  • Bipolar versus total hip endoprosthesis: functional results. Smrke, D.; Beden, Robert; Stankovski, Vlado // Archives of Orthopaedic & Trauma Surgery;May2000, Vol. 120 Issue 5/6, p259 

    Some functional parameters of the hip-joint 3.3 years on average (range 2–8.6 years) after hip arthroplasty are compared with regard to two types of hip endoprostheses: the total (TEP) and the bipolar (BPEP). Flexion, extension, abduction, adduction, and internal and external rotation...

  • Fifteen-year results of the Müller CoCrNiMo Straight Stem. Räber, Dieter A.; Czaja, Stephan; Morscher, Erwin W. // Archives of Orthopaedic & Trauma Surgery;Jan2001, Vol. 121 Issue 1/2, p38 

    Between September 1980 and May 1982, 112 primary unilateral total hip arthroplasties with the original cemented M. E. Müller Straight stem (manufactured from Protasul-10, a CoCrNiMo alloy) were inserted in 109 consecutive patients, all combined with non-cemented, non-coated polyethylene RM...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics