Mini-posterior approach favored in bilateral THA
By Elaine Fiedler
The rise of less invasive total hip arthroplasty (THA) has resulted in the development of several approaches, including various forms of smaller incision (mini-posterior, mini-anterior, mini-anterolateral) and two-incision techniques. A retrospective survey of patients who had bilateral THA—one side with a two-incision approach and the other using a mini-posterior THA—found that patients preferred the mini-posterior technique, according to the authors of Paper 196.
Much discussion has focused on the potential early functional benefits of the two-incision THA approach. The authors note, however, that most reports involved selected patients who were treated with advanced anesthetic and rehabilitation protocols, making comparison to historical data difficult. They received IRB approval for a retrospective study of 26 patients with bilateral THA to determine whether patients preferred a two-incision or mini-posterior approach.
All surgeries were staged, bilateral procedures performed by a single surgeon in 2003 and 2004. The patients were being treated for osteoarthritis, and all had a successful clincial outcome in both hips. The patient cohort included 10 males and 16 females, with an average age of 69 years (range: 42 to 80 years) at the time of the second THA. Each operation included the same comprehensive anesthesia protocol and rapid rehabilitation program.
Twelve patients had a two-incision THA done first; 14 patients had the mini-posterior THA done first. Patients completed a milestone diary at least 6 months after the second THA. They were asked questions such as how long they used walking aids, when they started driving and when they returned to work. They also were asked to state a preference for one hip or the other and to state a reason why.
Results showed that there was not a substantial difference in recovery time. Ambulatory aids were used for 27 days after the mini-posterior THA, and for 28 days after the two-incision procedure. Patients returned to driving 34 days after the mini-posterior THA and 32 days after the two-incision THA. The greatest difference was in return to work and normal stair climbing. In both cases, normal function was achieved substantially earlier after the mini-posterior THA.
Sixteen of the 26 patients (62 percent) preferred the mini-posterior hip. Of those, 50 percent said they had better early recovery, 25 percent cited a better cosmetic result, and 25 percent said a combination of better recovery and better cosmetic result.
The eight patients (31 percent) who preferred the two-incision THA attributed their preference to better early recovery. Two patients stated they had no preference.
"In this study," noted the authors, "the added technical difficulty of the two-incision THA was not rewarded with better function or greater patient satisfaction. The perceived better early functional results with the mini-posterior approach may be partly due to the variability and difficulty in protecting the abductor muscles with the two-incision technique."
The authors were Mark W. Pagnano, MD; Robert T. Trousdale, MD; R. Michael Meneghini, MD; and Arlen D. Hanssen, MD, all of Rochester, Minn. Drs. Pagnano and Hanssen receive royalties from Zimmer, Inc.