Minimally invasive hip surgery: the approach did not make the difference.

BACKGROUND: We hypothesized that minimally invasive surgery was superior to conventional surgery for total hip arthroplasty procedure. PURPOSE: To compare the results of total hip replacement (THR) made by minimally invasive lateral approach with the results of THR made by conventional lateral approach. MATERIALS AND METHODS: Prospective, randomized trial. Fifty patients were selected and then divided into two groups based on utilized approach. DATA COLLECTED: Perioperative bleeding, postoperative pain, time of recovery, components orientation, complications and functional results. Five-year follow-up. RESULTS: No differences were found in blood loss, postoperative pain, surgical time, components orientation, rate of complications or functional result. Minimally invasive lateral approach produced faster recovery with less hospital stay and earlier walking start. CONCLUSION: Our results suggested that minimally invasive lateral approach has not provided significant benefits over conventional lateral approach for the implantation of a total hip arthroplasty.

Abordaje posterior mínimamente invasivo en artroplastia total de cadera. Estudio prospectivo y aleatorizado. Un año de seguimiento / Minimally invasive posterior approach in total hip arthroplasty. Prospective randomised trial

Fundamento. La hipótesis de trabajo fue que la cirugíamínimamente invasiva era superior a la convencionalpara el proceso de artroplastia total de cadera. Paraello se compararon los resultados de la cirugía mínimamenteinvasiva con los de la cirugía convencional enartroplastia total de cadera.Material y métodos. Ensayo clínico prospectivo yaleatorizado. Se seleccionaron 50 pacientes, los cualesfueron divididos en dos grupos en función del abordajequirúrgico: posterior mínimamente invasivo o posteriordirecto convencional. Se evaluaron el sangradoperioperatorio, el dolor postoperatorio, el tiempo de recuperación,la orientación y ajuste de los componentes,la tasa de complicaciones y el resultado funcional y sehan seguido a los pacientes un año mínimo.Resultados. No se han encontrado diferencias significativasentre los grupos en cuanto a sangrado perioperatorio.El dolor postoperatorio fue menor con la cirugíamínimamente invasiva, la velocidad de recuperaciónfue significativamente mayor con el abordaje posteriormínimamente invasivo al detectarse una menor estanciahospitalaria y un inicio más precoz de la deambulación.No se encontraron diferencias en cuanto a tiempoquirúrgico, orientación y ajuste de los componentes,tasa de complicaciones ni resultado funcional. Impactoeconómico favorable a la cirugía mínimamente invasivacon un ahorro del 5% del total de coste del proceso.Conclusiones. El abordaje posterior mínimamente invasivodisminuye el dolor y acelera la recuperación conun impacto económico favorable, sin mostrar diferenciasen ninguna de los demás aspectos estudiados(AU)

Backgrond. Our working hypothesis was that minimallyinvasive surgery was superior to conventionalsurgery for total hip arthroplasty procedure. We comparedTHR results in the minimally invasive posteriorapproach with THR results in the conventional posteriorapproach.Methods. Prospective, randomised trial. Fifty patientswere selected and then divided into two groups basedon treatment (minimally invasive posterior approachor conventional posterior approach). Data collected:Perioperative bleeding, postoperative pain, time ofrecovery, component orientation, complications andfunctional results. One year follow-up.Results. No differences were found in blood loss, surgicaltime, component orientation, rate of complicationsor functional result. The minimally invasive lateralapproach produced less postoperative pain and a fasterrecovery, with a shorter hospital stay and earlierwalking-start, and a positive economic impact with 5%of the total process cost saved.Conclusions. Minimally invasive surgery permits lesspostoperative pain, faster recovery and a positiveeconomic saving, without differences in the rest of theitems studied(AU)

Abordaje lateral mínimamente invasivo en artroplastia total de cadera. Estudio prospectivo y aleatorizado / Minimally invasive lateral approach in total hip replacement: A prospective randomized study

Objetivo: Comparar los resultados de la corrección por vía posterior con una construcción híbrida mediante el empleo de una liberación posterior clásica y la liberación posterior ampliada (LPA). Material y métodos: Efectuamos un estudio de cohortes retrospectivo con 46 pacientes diagnosticados de escoliosis idiopática del adolescente (EIA). Se realizó una corrección por vía posterior mediante el empleo de una instrumentación híbrida. En el primer grupo se realizó una liberación posterior estándar (LPE) y en el segundo se realizó una LPA, y se resecaron todos los ligamentos posteriores y se realizó una facetectomía amplia bilateral. Se compararon los resultados de las mediciones en telerradiografías anteroposteriores y laterales preoperatorias, postoperatorias y a los 2 años. Se valoraron los resultados clínicos mediante el cuestionario SRS 22. Resultados: No hubo diferencias en cuanto al sexo, edad, tipo de curva, niveles instrumentados, tiempo quirúrgico o Cobb preoperatorio (LPE: 60°±10°; LPA: 59°±8°) de la curva principal. En el grupo de LPA la corrección obtenida fue significativamente mayor en el postoperatorio (p<0,001) y a los 2 años (p<0,05). La corrección de la curva proximal y lumbar resultó similar en ambos grupos y no se encontraron diferencias significativas. Las complicaciones menores fueron similares en ambos grupos y no existieron complicaciones graves. Conclusión: La LPA a múltiples niveles mejora la corrección de la curva principal en el plano coronal en los pacientes con EIA, sin aumento de la incidencia de complicaciones, además de aumentar la superficie de artrodesis y facilitar la introducción del alambrado (AU)

Purpose: To compare the results of posterior correction using hybrid instrumentation and classical posterior release with those obtained with an extended posterior release. Material and methods: We carried out a retrospective cohort study of 46 patients diagnosed with adolescent idiopathic scoliosis (AIS). A posterior correction was carried out using hybrid instrumentation. In the first group, a standard posterior release (SPR) was performed, whereas in the second an extended release (EPR) was carried out, resecting all posterior ligaments and performing an extended bilateral facetectomy. The results of the measurements were compared using pre-op, post-op and 2-year-follow-up anteroposterior and lateral teleradiographs. Clinical results were evaluated using the SRS 22 questionnaire. Results: There were no differences as regards gender, age, curve type, instrumented levels, OR time or pre-op Cobb's angle (SPR: 60°±10°; EPR: 59°±8°) of the principal curve. In the extended release group the correction obtained was significantly greater at post-op (p<0.001) and at 2 years (p<0.05). Correction of the proximal and lumbar curve was similar in both groups, with no significant differences. Minor complications were similar in both groups, with no serious complications. Conclusion: Multiple-level posterior release improves correction of the principal curve on the coronal plane in patients with AIS, without an increase in the complications rate. The procedure also extends the arthrodesed area and facilitates introduction of the wires (AU)

Minimally invasive osteosynthesis in stable trochanteric fractures: a comparative study between Gotfried percutaneous compression plate and Gamma 3 intramedullary nail.

AIM: Our objective was to compare the results of PCCP (Percutaneous Compression Plate) device and Gamma 3 nail for the treatment of stable trochanteric hip fractures and to demonstrate that PCCP device is a minimally invasive system. METHOD: Prospective, randomized trial. Eighty patients aged 60 and over with stable trochanteric fracture were selected and then randomized using a table of randomized numbers. Length of time of operative procedure, hemoglobin levels at 6 and 48 h after surgery, packed cells units administered, and hospital stay were recorded. In addition, the postoperative complications in the first year after the surgery was collected. RESULTS: No differences were found in hospital stay, surgical time, blood loss, functional outcome at 1-year follow-up, neck-shaft angle, fracture collapse, and mortality. CONCLUSIONS: PCCP and Gamma 3 have not presented significant differences in any measured parameter for treatment of stable trochanteric fractures. Therefore, the PCCP system is shown to be as minimally invasive as the Gamma 3.