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Saturday, February 26, 2005

Researchers find no significant differences between single- and dual-incision minimally invasive

Researchers for Poster P074 report that a stepwise introduction of minimally invasive total hip arthroplasty (THA) found no significant differences between a single incision using a posterior piriformis-sparing mini-approach and a dual incision.

Minimally invasive THA is a poorly defined heterogenous group of procedures that aim to limit soft tissue dissection in the insertion of a hip replacement. In an observer-blindedm prospective, randomized clinical trial consisting of 80 patients, researchers compared mini-posterior and dual-incision approaches to minimally invasive THA.

The dual-incision group showed significantly increased walking speed and lower physical dependence, based on the Iowa Level of Assistance scale. Despite a trend to earlier increases in the Harris Hip Score and decreased pain, these were not significantly different at 24 months follow up.

However, there were four perioperative proximal femoral fractures in the dual-incision group and 17 patients reported paraesthesia in the distribution of the lateral femoral cutaneous nerve (LFCN). There was no significant difference in blood loss or length of hospital stay between the dual- and single-incision groups (average of 2.6 days for dual incision and 3.1 days for single incision).

Despite excellent early functional outcomes, researchers remain concerned about the proximal femur fracture rate and incidence of LFCN paraesthesia when a dual-incision technique is used. They call for additional, muticentre, blinded, prospective, randomized clinical trials in minimally invasive THA.

Researchers included Daniel Fick, MD; Samantha Haebich; Professor Bo Nivbrant and Professor David Wood, all of Perth, Western Australia, and Riaz Khan, of Norwich, United Kingdom.

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