The Journal of Bone and Joint Surgery (American). 2008;90:1000-1006.
doi:10.2106/JBJS.G.00804
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Slower Recovery After Two-Incision Than Mini-Posterior-Incision Total Hip Arthroplasty

A Randomized Clinical Trial

Mark W. Pagnano, MD1, Robert T. Trousdale, MD1, R. Michael Meneghini, MD2 and Arlen D. Hanssen, MD1

1 Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
2 Joint Replacement Surgeons of Indiana, St. Vincent Center for Joint Replacement, 2001 West 86th Street, Indianapolis, IN 46260

Investigation performed at Mayo Clinic, Rochester, Minnesota

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Zimmer, DePuy). Also, a commercial entity (OREF [Orthopaedic Research and Education Foundation]) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: It has been claimed that the two-incision total hip arthroplasty technique provides quicker recovery than other methods do. To date, however, there have been no studies that have directly compared the two-incision technique with another method in similar groups of patients managed with the same advanced anesthetic and rehabilitation protocol. We posed the hypothesis that patients managed with two-incision total hip arthroplasty would recover faster than those managed with mini-posterior-incision total hip arthroplasty and designed a randomized controlled trial specifically (1) to determine if patients recovered faster after two-incision total hip arthroplasty than after mini-posterior-incision total hip arthroplasty as measured on the basis of the attainment of functional milestones that reflect activities of daily living, (2) to determine if the general health outcome after two-incision total hip arthroplasty was better than that after mini-posterior-incision total hip arthroplasty as measured with Short Form-12 (SF-12) scores, and (3) to evaluate the surgical complexity of the two procedures on the basis of the operative time and the prevalence of early complications.

Methods: Between November 2004 and January 2006, seventy-two patients undergoing total hip arthroplasty were randomized to two treatment groups: one group was managed with the two-incision technique, and the other group was managed with the mini-posterior-incision technique. The two-incision group comprised thirty-six patients (twenty men and sixteen women) with a mean age of sixty-seven years and mean body mass index of 28.7. The mini-posterior-incision group comprised thirty-six patients (twenty men and sixteen women) with a mean age of sixty-six years and a mean body mass index of 30.2. All patients received the same design of uncemented acetabular and femoral components and were managed with the same comprehensive perioperative pain management and rapid rehabilitation protocol. Operative times and complications were recorded. At two months and one year, all patients were assessed with regard to functional outcome and general health outcome.

Results: The patients in the two-incision group recovered more slowly than did those in the mini-posterior-incision group as measured on the basis of the mean time to discontinue a walker or crutches, to discontinue all walking aids, and to return to normal daily activities. The clinical outcome as measured on the basis of the SF-12 scores was similar at both two months and one year postoperatively. The two-incision total hip arthroplasty was a more complex surgical procedure, with a mean operative time that was twenty-four minutes longer; however, the rate of complications (2.8%; one of thirty-six) was the same in the two groups.

Conclusions: Our hypothesis that the two-incision technique for total hip arthroplasty would substantially improve the short-term recovery after total hip arthroplasty compared with the mini-posterior incision technique was not proved; instead, the patients managed with the mini-posterior-incision technique had the quicker recovery.

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


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T. P. Vail, E. M. Mariani, M. H. Bourne, R. A. Berger, and R. M. Meneghini
Approaches in Primary Total Hip Arthroplasty
J. Bone Joint Surg. Am., August 1, 2009; 91(Supplement_5): 10 - 12.
[Abstract] [Full Text] [PDF]