Introduction: Minimally invasive total hip arthroplasty has evoked substantial controversy with regard to whether it provides superior outcomes compared with conventional total hip arthroplasty. The objective of this study was to compare the results of a minimal invasive direct anterior approach (MIDA) with those of a conventional lateral transgluteal approach (CLT).

Methods: 120 patients (120 hips) admitted for unilateral total hip arthroplasty were randomized to undergo surgery via minimal invasive direct anterior or conventional lateral transgluteal approach. Patients with a body mass index of more than 35, previous hip surgery, preoperative neurological deficits and with an age of more than 80 years were excluded. Two surgeons performed all procedures. To estimate muscle damage serum creatinkinase was assessed. Blood loss was calculated according to Rosencher by comparing preoperative to postoperative hematocrit. Postoperative pain and the ability to perform the activities of daily living were recorded in a dairy via modified WOMAC first on a daily basis, then on each second day and finally once a week for a total of 12 weeks. WOMAC questionnaire and SF-36 were administered at 6 weeks and 3 months follow-up.

Results: The groups were similar demographically. Patients in MIDA group had significantly less total blood loss (p = 0.006), postoperative blood levels of creatinine kinase were significantly lower (p = 0.001). Operative time was similar in both groups, we found no difference in component placement. Physical component summary of SF-36 at 12 weeks follow-up showed a significant benefit for the MIDA group. Averaged modified WOMAC scores and their pain and function subscores demonstrated a clear advantage on every recorded day during the first 12 weeks for MIDA. Median WOMAC sum score and respective pain as well as function subscores were better in the MIDA group at 6 and 12 weeks follow up.

Conclusions: A minimally invasive direct anterior approach is superior to a conventional lateral transgluteal approach with regard to blood loss and muscle trauma, resulting in better health related quality of life in the first three months after operation.

Study Design/Objective: Prospective two-leg cohort study on anterior cervical fusion versus cervical arthroplasty with emphasis on clinical outcome measures.

Patients and Methods: Between August 2003 and May 2005 21 consecutive patients underwent anterior cervical fusion with or without anterior decompression with 26 levels fused. Between December 2004 and August 2006 24 patients had cervical arthroplasty with 30 levels replaced. The mean age at operation of the fusion group was 52 years and 5 months (46–69) and for the arthroplasty group 51 years and 2 months (42–62). To establish fusion the Cervios® cage (Synthes) with or without anterior plating was used. In the arthroplasty group the Prodisc C® disc prothesis (Synthes) was used. Contraindication for arthroplasty were osteoporosis, osteopathies, spinal canal stenosis, hypertrophic spondylarthrosis, spondylolisthesis, tumors and privious infection. Both groups were comparable with respect to age and gender, diagnosis, level distribution and preoperative clinical outcome measures (VAS for nack pain and arm pain, neck disability index and SF-36–sub-scores pain, function, vitality).

Results: Postoperatively all of the clinical outcome measures significantly improved in both groups. After three months postoperatively no significant further improvement was evident.

VAS neck pain: Fusion group/arthroplasty group: Preoperatively 6.2/5.9 n.s., 6 weeks 3.5/3.1 n.s., 12 weeks 2.1/1.9 n.s, 1 year 2/2.1 n.s.

In the fusion group we had 1 recurrent radiculopathy and 1 non union without the need of further intervention. In the arthroplasty group we faced 1 recurrent laryngeus recurrens nerve palsy and 3 spontaneus fusions within 1 year postoperatively, which might not be classified as complication.

Conclusion: Short term outcome after both procedures is excellent in terms of pain relief and function. 10% spontaneus fusion after disc replacement within the first year was evident. In our series we found better results after 3 months to 1 year postoperatively with respect to the neck disability index and SF-36 subscore pain within the arthroplasty group.