Minimally Invasive Surgical Approaches and Traditional Total Hip Arthroplasty: A Meta-Analysis of Radiological and Complications Outcomes

BACKGROUND: Minimally invasive total hip arthroplasty (MITHA) remains considerably controversial. Limited visibility and prosthesis malposition increase the risk of post-surgical complications compared to those of the traditional method. METHODS: A meta-analysis was undertaken of all published databases up to May 2011. The studies were divided into four subgroups according to the surgical approach taken. The radiological outcomes and complications of minimally invasive surgery were compared to traditional total hip arthroplasty (TTHA) using risk ratio, mean difference, and standardized mean difference statistics. RESULTS: In five studies involving the posterolateral approach, no significant differences were found between the MITHA groups and the TTHA groups in the acetabular cup abduction angle (p = 0.41), acetabular anteversion (p = 0.96), and femoral prosthesis position (p = 0.83). However, the femoral offset was significantly increased (WMD = 3.00; 95% CI, 0.40–5.60; p = 0.02). Additionally, there were no significant differences among the complications in both the groups (dislocations, nerve injury, infection, deep vein thrombosis, proximal femoral fracture) and revision rate (p>0.05). In three studies involving the posterior approach, there were no significant differences in radiological outcomes or all other complications between MITHA or TTHA groups (p>0.05). Three studies involved anterolateral approach, while 2 studies used the lateral approach. However, the information from imaging and complications was not adequate for statistical analysis. CONCLUSIONS: Posterior MITHA seems to be a safe surgical procedure, without the increased risk of post-operative complication rates and component malposition rates. The posterolateral approach THA may lead to increased femoral offset. The current data are not enough to reach a positive conclusion that lateral and anterolateral approaches will result in increased risks of adverse effects and complications at the prosthesis site.