COMPARISON OF PATIENT SCAR SATISFACTION IN MINI VERSUS STANDARD INCISIONS IN THE POSTERIOR APPROACH FOR TOTAL HIP REPLACEMENT

Abstract

Background: Mini-incision surgery (MIS) for total hip replacement (THR) typically uses incisions of 10cm or less and therefore may offer a better cosmetic appearance. Reported advantages of MIS include decreased blood loss, less tissue trauma and decreased pain, all of which are equivocal by six weeks post-surgery, when compared with standard incisions. The aim of this study was to compare patient scar satisfaction and identify potential long-term benefits of this incision when used in the posterior approach for THR.

Methods: Two groups of patients who underwent primary THR were reviewed. Group 1 consisted of 43 patients who underwent THR via a mini-incision, with a mean incision length of 9.44cm. Group 2 consisted of 51 patients who had a posterior standard incision, with a mean length of 15.3cm. The average length of follow-up was 12.8 months (range 2 – 48 months). There were no wound complications in either group. Scars were assessed using the validated Manchester Scar Proforma (MSP) and Visual Analogue Scales (VAS), and patients completed a Patient Scar Assessment Scale.

Results: The mean combined MSP and VAS scores for Group 1 and Group 2 were 7.2 and 7.1 respectively. The mean Patient Scar Assessment Scale score was 8.8 in group 1, and 10.4 in Group 2. The single parameter that scored highest in the Patient Scar Assessment Scale was the colour of the scar. This did not vary between the two groups of patients. There was no statistical significance in any of the parameters measured.

Conclusion: There does not appear to be any cosmetic benefit from MIS, when performing THR via the posterior approach. The length of wound was of little concern to patients, while the colour of the scar was the highest-scoring factor in the Patient Scar Assessment Scale. We therefore conclude that there is no long-term benefit from mini-incision surgery for THR via the posterior approach.