The choice of surgical technique for total hip arthroplasty (THA) can affect time and postoperative rehabilitation procedures. The aim of this prospective blinded cohort study is to determine significant differences in gait parameters in the short term between those patients who have experienced THA using a limited incision anterolateral intermuscular (MIS) approach compared with those who have experienced traditional lateral transmuscular (LTM) approach.

Thirty patients were enrolled in this study, 15 of who received the MIS technique and 15 the LTM approach. A single surgeon performed all the operations using short hip stem implants with 36mm femoral head size and all patients received a standard postoperative rehabilitation protocol. Patients, physiotherapists, and assessors were blinded to the incision used. Gait analysis was performed 30 day after surgery, when patients were able to ambulate without crutches.

Minimal differences in temporostatial parameters were shown between the MIS and LTM groups, whereas significant differences (p< 0.05) in kinematics (hip range of motion in sagittal, frontal and transverse planes), kinetics (hip flexion/extension and abduction/adduction moments) and electromiography parameters (gluteus medius activation pattern and degree of activity) between two groups.

This study demonstrates functional benefits of the minimally invasive incision over the standard lateral transmuscular approach in terms of walking ability 30 days postoperatively.

Introduction: In the last few years minimally invasive surgery in hip replacement is becoming more popular among orthopaedic surgeons because of less morbidity and faster rehabilitation. However several complications have been reported expecially in the so called “learning curve” (first twenty cases). The purpose of this study is to evaluate the learning curve of three different minimally invasive approaches.

Methods and Materials: In this study three different surgical approaches of THA were evaluated: lateral mini incision (GroupA), minimally invasive anterior approach (GroupB) and minimally invasive antero lateral approach (GroupC). The first twenty cases of each surgical approach were selected and compared with a control group (GroupD) of 149 total hip replacement operated using a lateral standard approach (> 12 cm) in the same period by the same experienced surgeon.

In all cases a specialized dedicated surgical instrumentation was used. Inclusion criteria to enter the study group (A-B-C Groups) were:BMI< 30, diagnosis of primary osteoarthritis, age< 75 years.

Following parameters were evaluated: intra and post operative complications, total blood loss, time of surgery, component placement, length of hospital stay and functional outcomes (HHS, WOMAC) at six weeks.

Results: No dislocations, infections and early aseptic loosening were detected in groups A, B and C. No significant differences were detected regarding the length of hospital stay in all groups. In group B the time of surgery was significantly higher than in group D. The total blood loss of group A, B and C was statistically lower than group D. Clinical outcomes at six weeks in groups B and C were significantly better that in group A and D. The following complications were detected:

Group A: two sciatic nerve palsy (one transient and one permanent), one greater trochanter fracture, one femoral stem malposition.

Group B: one greater trochanter fracture, one proximal femoral fracture, one rupture of tensor fasciae latae, two haematomas.

Group C: no complications were detected.

In control group D (149 patients) the following complications were observed: one proximal femoral fracture, one case of cup malposition and one infection.

Conclusions: The main advantages of all MIS approaches seem to be the reduced total blood loss, even in the learning curve. However during learning curve the minimally invasive approaches seem to have a higher rate of complications than the standard procedures even in selected patients. In muscle sparing approaches (anterior and antero lateral) the early functional outcomes are better than other approaches (standard and mini incision). Among the evaluated minimally invasive procedures, the antero lateral approach seems to be safer and less demanding than others.