The Journal of Bone and Joint Surgery (American). 2007;89:1153-1160.
doi:10.2106/JBJS.F.00940
© 2007 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow CME: Take the exams for this article:
 CME 2: April, May, June 2007 (publication date July 5, 2007; expiration dat...
Adult Hip Reconstruction Test 25: Summer 2007 (publication date August 15, ...
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Dorr, L. D.
Right arrow Articles by Sirianni, L. E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Dorr, L. D.
Right arrow Articles by Sirianni, L. E.
Related Collections
Right arrow Adult Hip
Right arrow Pain Management
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?

Early Pain Relief and Function After Posterior Minimally Invasive and Conventional Total Hip Arthroplasty

A Prospective, Randomized, Blinded Study

Lawrence D. Dorr, MD1, Aditya V. Maheshwari, MD1, William T. Long, MD1, Zhinian Wan, MD1 and Leigh Ellen Sirianni, OPA-C1

1 The Arthritis Institute, 501 East Hardy Street, 3rd Floor, Inglewood, CA 90301. E-mail address for L.D. Dorr: Patriciajpaul{at}yahoo.com

Investigation performed at The Arthritis Institute, Inglewood, California

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Zimmer. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Few prospective randomized studies have demonstrated benefits of minimally invasive total hip arthroplasty when compared with conventional total hip arthroplasty. We hypothesized that patients treated with a posterior mini-incision would have better results than those treated with a posterior long incision with regard to the achievement of established goals for pain relief and functional recovery permitting hospital discharge by the second postoperative day.

Methods: Sixty of 231 eligible patients were randomized (with thirty in each group) to have a total hip arthroplasty performed through either a posterior mini-incision (10 ± 2 cm) or a traditional long incision (20 ± 2 cm). After completion of the total hip arthroplasty, the mini-incision group underwent extension of the skin incision to 20 cm. Patients were evaluated on the basis of self-determined pain scores, requirements for pain medicine, need for assistive gait devices, and time until discharge. Gait analysis provided objective functional assessment.

Results: The average hospital stay was 63.2 ± 13.3 hours in the mini-incision group and 73.6 ± 23.5 hours in the long-incision group (p = 0.04). More patients with a mini-incision were discharged by the second postoperative day (p = 0.003) and more were using just a single assistive device at the time of discharge (p = 0.005). As scored on a verbal analog scale of 0 to 10 points, patients with a mini-incision had less pain on each postoperative day and the pain score remained significantly lower at the time of discharge (mean, 2.2 ± 1.0 points compared with 3.1 ± 0.9 points in the long-incision group; p = 0.002). After hospital discharge, there were no clinical differences in pain or function between the two groups of patients.

Conclusions: Compared with conventional total hip arthroplasty performed through a posterior incision, posterior minimally invasive total hip arthroplasty resulted in better early pain control, earlier discharge to home, and less use of assistive devices. Subsequent evaluations at six weeks and three months showed equivalency between the clinical results in the two groups.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 JBJSHome page
J. C. Clohisy, P. E. Beaule, A. O'Malley, M. R. Safran, and P. Schoenecker
AOA Symposium. Hip Disease in the Young Adult: Current Concepts of Etiology and Surgical Treatment
J. Bone Joint Surg. Am., October 1, 2008; 90(10): 2267 - 2281.
[Full Text] [PDF]

Home page
 JBJSHome page
M. H. Huo, J. Parvizi, B. S. Bal, and M. A. Mont
What's New in Total Hip Arthroplasty
J. Bone Joint Surg. Am., September 1, 2008; 90(9): 2043 - 2055.
[Full Text] [PDF]

Home page
 JBJSHome page
N. N. Mahomed, A. M. Davis, G. Hawker, E. Badley, J. R. Davey, K. A. Syed, P. C. Coyte, R. Gandhi, and J. G. Wright
Inpatient Compared with Home-Based Rehabilitation Following Primary Unilateral Total Hip or Knee Replacement: A Randomized Controlled Trial
J. Bone Joint Surg. Am., August 1, 2008; 90(8): 1673 - 1680.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
M. W. Pagnano, R. T. Trousdale, R. M. Meneghini, and A. D. Hanssen
Slower Recovery After Two-Incision Than Mini-Posterior-Incision Total Hip Arthroplasty. A Randomized Clinical Trial
J. Bone Joint Surg. Am., May 1, 2008; 90(5): 1000 - 1006.
[Abstract] [Full Text] [PDF]