Minimally Invasive Approaches for Total Hip Arthroplasty: Systematic Review

Abstract

Introduction. Main objective of total hip replacement (THR) is fast recovery of hip joint function and patient’s return to daily routines. Use of minimally invasive approaches (MIA) may help achieving set objective. The purpose of the study was to analyze and compare MIA in THR.Materials and methods. Databases of PubMed, Scopus, Cochrane Systematic Reviews, Google Scholar and E-library were searched for the period since 2000 to 2020. 55 scientific articles were selected for the analysis. Publications contain results of studies of MIA, such as Direct Anterior Approach (DAA), Micro-Hip (MH), Röttinger (R), Mini-posterior (MP), Direct Superior Approach (DSA), SuperCap (SC), PATH (P), SuperPATH (SP). The initial data were combined and underwent statistical processing.Results. A comparative analysis of MIA couldn’t identify superiority of any approach. Blood loss, length of hospital stay, functional outcomes (Harris Hip Score) at 3 and 12 months didn’t differ between the groups. Significant differences were found in the operation time between DSA and SP. Acetabular inclination was different between some approaches. Cup inclination in R and DSA, cup anteversion in DAA, MH and SP slightly exceeded Lewinnek's «safe zone». Recurrent dislocation, periprosthetic fractures, damage to the lateral cutaneous nerve are the most frequent postoperative complications.Conclusion: THR can be done using a variety of surgical approaches. The choice of approach relies on surgeon’s experience and personal preferences. Minimally invasive approaches have the advantage of short-term recovery due to the preservation of soft tissues.