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Saturday, February 26, 2005

Tips on minimally invasive THA shown

Minimally invasive total hip arthroplasty (THA) can be both efficient and effective, especially if you follow the surgical tips outlined in Scientific Exhibit 005. The tips were gleaned from more than 1,500 THA minimal incision surgeries (MIS), using a posterior approach, over a 15-year period.

MIS was compared with standard incisions in a published series (Orthopedics Feb 2000) of 796 total joint arthroplasties performed from 1993 to 1995 by 20 orthopedic surgeons. In that study, 200 patients had MIS THA. MIS surgical time averaged 27 minutes (compared to 107 minutes for a standard incision). MIS THA also resulted in less blood loss, shorter hospital stays, and lower total hospital charges. For example, MIS THA used an average of 0.37 units of blood per patient, compared to 0.92 units for standard incision THA. Duration of hospital stay was 3.6 days for an MIS THA patient, compared to 5.2 days for a patient who had a standard incision. This resulted in saving more than $3,000 in hospital charges ($17, 992 for MIS THA vs. $21,103 for standard incision THA). These results were statistically signficant.

The exhibit includes several surgical tips on an 8-minute video, which is based on a longer video, available through the AAOS (Product #13114). The tips include:

  • Palpate site of incision at posterior abductor margin
  • Blunt dissect gluteus maximus and apply retractor
  • Identify piriformis
  • Electrocauterize posterior cervical vessels
  • Divide femoral neck in situ
  • Anterior capsulectomy
  • Apply blunt retractors for acetabulum and femur exposure
  • Close all divided structures.

Using this technique, the author found no differences in long-term objective clinical or radiological outcomes compared with five other authors using the same implant and standard incisions. Portable gait analysis failed to reveal limping in MIS patients. An objective activity monitor revealed less effort for the surgeon to accomplish the MIS THA. Other objective outcome analysis is ongoing.

The exhibit was prepared by D. Kevin Lester, MD, of Fresno, Calif. Dr. Lester is a stockholder in OTI and minisun.

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