Robot-assisted primary cementless total hip arthroplasty with a short femoral stem: a prospective randomized short-term outcome study [Clinical outcome following robotic assisted versus conventional total hip arthroplasty: a controlled and prospective study of seventy-one patients]. A Comparison between Robotic-assisted and Manual Implantation of Cementless Total Hip Arthroplasty Robot-assisted primary cementless total hip arthroplasty with a short femoral stem: a prospective randomized short-term outcome study. Effect of robotic milling on periprosthetic bone remodeling. Robot‐assisted total hip arthroplasty: Clinical outcomes and complication rate Comparison of Robotic-assisted and Conventional Acetabular Cup Placement in THA: A Matched-pair Controlled Study Comparison of robotic-assisted and conventional manual implantation of a primary total knee arthroplasty. Comparison of robotic-assisted and manual implantation of a primary total hip replacement. A prospective study. Comparison of gait in patients following a computer-navigated minimally invasive anterior approach and a conventional posterolateral approach for total hip arthroplasty: a randomized controlled trial. Antero-lateral minimal invasive (ALMI) approach for total hip arthroplasty technique and early results Mini-incision technique for total hip arthroplasty with navigation. Time course and extent of functional recovery during the first postoperative year after minimally invasive total hip arthroplasty with two different surgical approaches--a randomized controlled trial. [Comparison of total hip arthroplasty via a posterior mini-incision versus a classic anterolateral approach]. Objective functional assessment of total hip arthroplasty following two common surgical approaches: The posterior and direct lateral approaches Minimally Invasive versus Classic Procedures in Total Hip Arthroplasty: A Double-blind Randomized Controlled Trial Reduction of blood loss using tranexamic acid in total knee and hip arthroplasties A comparison of total hip resurfacing and total hip arthroplasty - patients and outcomes. Resurfacing is Comparable to Total Hip Arthroplasty at Short-term Followup Minimally invasive total hip arthroplasty: a randomized controlled prospective trial Preliminary application of computer-assisted patient-specific acetabular navigational template for total hip arthroplasty in adult single development dysplasia of the hip. Total Hip Arthroplasty through the Mini-Incision (Micro-Hip) Approach versus the Standard Transgluteal (Bauer) Approach: A Prospective, Randomised Study The effect of total hip arthroplasty surgical approach on postoperative gait mechanics.
Abstract Background : Recently , two topical issues in total hip arthroplasty ( THA ) have been robot-assisted surgery and use of a short stem . The purpose of this study was to evaluate the effects of robotic milling on the accuracy of short femoral stem positioning and on the short-term clinical outcome in THA using a prospect i ve , r and omized design . Methods : We r and omized 54 patients into two groups , either robotic milling group or manual rasping group .  The patients were assessed clinical ly and radiographically at 8 weeks , 5 months , 12 months , and 24 months . Results : Robotic milling group had a significantly longer operation time , requiring on average 8.9 min for registration and 11.2 min for milling . On the other h and , robotic milling group showed superior results in terms of stem alignment and leg length e quality . Two intraoperative femoral fractures occurred only in manual rasping group . Harris hip scores and WOMAC scores at 24 months postoperatively were similar in both groups . No complications including stem loosening , infection , nerve palsy , or dislocation were encountered in either group during the follow-up period . Conclusions : The present study suggested that robot-assisted short stem THA could increase the accuracy of stem alignment , improve leg length e quality , and help reduce the risk of intraoperative femoral fracture as compared with manual rasping . However , the clinical outcome scores did not differ between the two groups at the time of short-term follow-up . Long-term follow-up is needed to determine whether there will be a long-term clinical relevance of robot-assisted implantation of short femoral stems in THA AIM Robotic assisted total hip arthroplasty  remains controversial , since wider exposure of the proximal femur and placement of the leg in maximal hip adduction and external rotation using a rigid leg-holder apparatus may impair significantly the hip abductors . Consequently , it is the purpose of this study to analyse and report both clinical outcome and hip abductor function following robotic assisted versus conventional total hip arthroplasty . MATERIAL AND METHODS 36 robotic-assisted ( CASPAR , Orto-Maquet , Rastatt , Germany ) and 35 conventional cementless total hip arthroplasties  were followed on average for 18 months regarding incidence of complications , Harris hip score , the scoring system according to Merle d'Aubigné and Postel , hip abductor function ( using a spring-balance ) , and incidence of Trendelenburg 's sign ( according to the Kuhfuss-classification ) . Statistical analysis was performed in case of continuous data using the t test and the Mann-Whitney test , respectively , and in case of categorical data using Fisher 's exact test and the chi-squared test , respectively . The level of significance was set as p < 0.05 . RESULTS Average duration of surgery ( CASPAR : 100.6 min ; conventional : 51.5 min ; p < 0.0001 ) as well as average loss of haemoglobin ( CASPAR : 4.5 mg/dL ; conventional : 3.3 mg/dL ; p = 0.0002 ) differed significantly , whereas the incidence of complications ( CASPAR : two dislocations , one sciatic paresis , one deep infection ; conventional : one dislocation , two fissures ) , revision rate ( CASPAR : 5.6 % ; conventional : 2.9 % ) , and incidence of heterotopic ossifications ( CASPAR : 30.6 % ; conventional : 17.1 % ) was comparable following both procedures ( p > 0.05 ) . Improvement of the Harris hip score also was comparable in both groups ( CASPAR : 40.9 to 86.1 points ; conventional : 39.5 to 88.0 points ; p = 0.21 ) , whereas improvement of the score according to Merle d'Aubigné and Postel was significantly greater following the manual procedure ( CASPAR : 10.1 to 16.0 points ; conventional : 8.3 to 16.6 points ; p < 0.0001 ) . Differences between the two groups were also significant regarding hip abductor function ( CASPAR : 76.1 % ; conventional : 93.8 % of the contralateral hip ; p < 0.0001 ) and incidence of Trendelenburg 's sign ( CASPAR : 61.1 % ; conventional : 25.7 % ; p = 0.0014 ) . CONCLUSION The significant functional impairment following robotic assisted THA should be taken critically into consideration prior to initiating such procedure Background The benefits of robotic techniques for implanting femoral components during THA are still controversial . Questions / Purpose sThe purpose of this study was to prospect ively compare the results and complications of robotic-assisted and h and -rasping stem implantation techniques . Method The minimum followup was 5 years ( mean , 67 months ; range , 60–85 months ) . One hundred forty-six primary THAs on 130 patients were included in this study .  Robot-assisted primary THA was performed on 75 hips and a h and -rasping technique was used on 71 hips . Results At 2 and 3 years postoperatively , the Japanese Orthopaedic Association ( JOA ) clinical score was slightly better in the robotic-assisted group . At 5 years followup , however , the differences were not significant . Postoperative limb lengths of the robotic-milling group had significantly less variance than the h and -rasping group . At 2 years postoperatively , there was significantly more stress shielding of the proximal femur in the h and -rasping group ; this difference was more significant 5 years postoperatively . Conclusions Substantially more precise implant positioning seems to have led to less variance in limb-length ine quality and less stress shielding of the proximal femur 5 years postoperatively . Level of Evidence Level II , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence BACKGROUND Recently , two topical issues in total hip arthroplasty ( THA ) have been robot-assisted surgery and use of a short stem . The purpose of this study was to evaluate the effects of robotic milling on the accuracy of short femoral stem positioning and on the short-term clinical outcome in THA using a prospect i ve , r and omized design . METHODS We r and omized 54 patients into two groups , either robotic milling group or manual rasping group .  The patients were assessed clinical ly and radiographically at 8 weeks , 5 months , 12 months , and 24 months . RESULTS Robotic milling group had a significantly longer operation time , requiring on average 8.9 min for registration and 11.2 min for milling . On the other h and , robotic milling group showed superior results in terms of stem alignment and leg length e quality . Two intraoperative femoral fractures occurred only in manual rasping group . Harris hip scores and WOMAC scores at 24 months postoperatively were similar in both groups . No complications including stem loosening , infection , nerve palsy , or dislocation were encountered in either group during the follow-up period . CONCLUSIONS The present study suggested that robot-assisted short stem THA could increase the accuracy of stem alignment , improve leg length e quality , and help reduce the risk of intraoperative femoral fracture as compared with manual rasping . However , the clinical outcome scores did not differ between the two groups at the time of short-term follow-up . Long-term follow-up is needed to determine whether there will be a long-term clinical relevance of robot-assisted implantation of short femoral stems in THA The ROBODOC system has provided better fit and fill of the stem and less destruction of the bony architecture than with manual surgery . These benefits might affect femoral periprosthetic bone remodeling . We evaluated the effects of robotic milling in cementless total hip arthroplasty ( THA ) in a longitudinal 24-month follow-up study using dual energy X-ray absorptiometry ( DEXA ) and plain radiographs of 29 patients ( 31 hips ) after ROBODOC THA and 24 patients ( 27 hips ) after manual THA with the same stem design . To minimize the influence of other factors on bone remodeling , only female osteoarthritis patients , who had no drugs that might affect bone metabolism were enrolled . Significantly less bone loss occurred at the proximal periprosthetic areas in the ROBODOC group . In zone 1 , the decrease was 15.5 versus 29.9 % using conventional rasping ; in zone 7 , the loss was 17.0 % with ROBODOC compared to 30.5 % with conventional rasping ( p < 0.05 ) . On radiographs , endosteal spot welds in the proximal medial portion were more pronounced in the ROBODOC group ( 48 vs. 11 % in the conventional group , p < 0.05 ) . Our results suggest that robotic milling is effective in facilitating proximal load transfer around the femoral component and minimizing bone loss after cementless THA BACKGROUND The purpose of this study was to report minimum 2-year outcomes and complications for robotic-arm-assisted total hip arthroplasty ( THA )  . METHODS Data were prospect ively collected and retrospectively review ed between June 2011 and April 2014 . Inclusion criteria were primary robotic-arm-assisted THAs treating idiopathic osteoarthritis with ≥ 2-year follow-up .  Demographics , operating time , complications , 2-year outcome scores and satisfaction , and subsequent surgeries were recorded . RESULTS There were 181 cases eligible for inclusion , of which 162 ( 89.5 % ) had minimum 2-year follow-up . At the latest follow-up , the mean visual analogue scale was 0.7 , satisfaction was 9.3 , Harris hip score was 91.1 and forgotten joint score was 83.1 . Six ( 3.7 % ) intraoperative complications and six ( 3.7 % ) postoperative complications were reported . No leg length discrepancies ( LLDs ) or dislocations were reported . CONCLUSIONS Robotic-arm-assisted THA demonstrates favourable short-term outcomes and does not result in a higher complication rate compared to non-robotic THA as reported by the literature Background Improper acetabular component orientation in THA has been associated with increased dislocation rates , component impingement , bearing surface wear , and a greater likelihood of revision . Therefore , any reasonable steps to improve acetabular component orientation should be considered and explored . Questions / purpose sWe therefore sought to compare THA with a robotic-assisted posterior approach with manual alignment techniques through a posterior approach , using a matched-pair controlled study design , to assess whether the use of the robot made it more likely for the acetabular cup to be positioned in the safe zones described by Lewinnek et al. and Callanan et al. Methods Between September 2008 and September 2012 , 160 THAs were performed by the senior surgeon . Sixty-two patients ( 38.8 % ) underwent THA using a conventional posterior approach , 69 ( 43.1 % ) underwent robotic-assisted THA using the posterior approach , and 29 ( 18.1 % ) underwent radiographic-guided anterior-approach THAs .  From September 2008 to June 2011 , all patients were offered anterior or posterior approaches regardless of BMI and anatomy . Since introduction of the robot in June 2011 , all THAs were performed using the robotic technique through the posterior approach , unless a patient specifically requested otherwise . The radiographic cup positioning of the robotic-assisted THAs was compared with a matched-pair control group of conventional THAs performed by the same surgeon through the same posterior approach . The safe zone ( inclination , 30 ° –50 ° ; anteversion , 5 ° –25 ° ) described by Lewinnek et al. and the modified safe zone ( inclination , 30 ° –45 ° ; anteversion , 5 ° –25 ° ) of Callanan et al. were used for cup placement assessment . Matching criteria were gender , age ± 5 years , and ( BMI ) ± 7 units . After exclusions , a total of 50 THAs were included in each group . Strong interobserver and intraobserver correlations were found for all radiographic measurements ( r > 0.82 ; p < 0.001 ) . Results One hundred percent ( 50/50 ) of the robotic-assisted THAs were within the safe zone described by Lewinnek et al. compared with 80 % ( 40/50 ) of the conventional THAs ( p = 0.001 ) . Ninety-two percent ( 46/50 ) of robotic-assisted THAs were within the modified safe zone described by Callanan et al. compared with 62 % ( 31/50 ) of conventional THAs p ( p = 0.001 ) . The odds ratios for an implanted cup out of the safe zones of Lewinnek et al. and Callanan et al. were zero and 0.142 , respectively ( 95 % CI , 0.044 , 0.457 ) . Conclusions Use of the robot allowed for improvement in placement of the cup in both safe zones , an important parameter that plays a significant role in long-term success of THA . However , whether the radiographic improvements we observed will translate into clinical benefits for patients —such as reductions in component impingement , acetabular wear , and prosthetic dislocations , or in terms of improved longevity — remains unproven . Level of Evidence Level III , therapeutic study . See the Instructions for Authors for a complete description of levels of evidence This study was aim ed to compare robotic-assisted implantation of a total knee arthroplasty with conventional manual implantation . We controlled , r and omized , and review ed 72 patients for total knee arthroplasty assigned to undergo either conventional manual implantation ( excluding navigation-assisted implantation cases ) of a Zimmer LPS prosthesis ( Zimmer , Warsaw , Ind ) ( 30 patients : group 1 ) or robotic-assisted implantation of such a prosthesis ( 32 patients : group 2 ) . The femoral flexion angle ( gamma angle ) and tibial angle ( delta angle ) in the lateral x-ray of group 1 were 4.19 + /- 3.28 degrees and 89.7 + /- 1.7 degrees , and those of group 2 were 0.17 + /- 0.65 degrees and 85.5 + /- 0.92 degrees . The major complications were from improper small skin incision during a constraint attempt of minimally invasive surgery and during bulk fixation frame pins insertion . Robotic-assisted technology had definite advantages in terms of preoperative planning , accuracy of the intraoperative procedure , and postoperative follow-up , especially in the femoral flexion angle ( gamma angle ) and tibial flexion angle ( delta angle ) in the lateral x-ray , and in the femoral flexion angle ( alpha angle ) in the anteroposterior x-ray . But a disadvantage was the high complication rate in early stage BACKGROUND Robotic-assisted total hip replacement  has become a common method of implantation , especially in Europe . It frequently has been postulated that robotic reaming would result in an improved clinical outcome due to the better fit of the prosthesis , but that has never been demonstrated in a prospect i ve study , to our knowledge . The purpose of this study was to compare robotic-assisted implantation of a total hip replacement with conventional manual implantation . METHODS One hundred and fifty-four patients scheduled for total hip replacement were r and omly assigned to undergo either conventional manual implantation of an S-ROM prosthesis ( eighty patients ) or robotic-assisted implantation of such a prosthesis ( seventy-four patients ) . The five-axis ROBODOC was used for the robotic-assisted procedures . Preoperatively as well as at three , six , twelve , and twenty-four months after surgery , the scores according to the Harris and Merle d'Aubigné systems and the Mayo clinical score were determined . Radiographs made at these intervals were analyzed for evidence of loosening , prosthetic alignment , and heterotopic ossification . RESULTS Thirteen ( 18 % ) of the seventy-four attempted robotic implantations had to be converted to manual implantations as a result of failure of the system . The duration of the robotic procedures  was longer than that of the manual procedures ( mean and st and ard deviation,107.1 + /- 29.1 compared with 82.4 + /- 23.4 minutes , p < 0.001 ) . Limb-length e quality ( mean discrepancy , 0.18 + /- 0.30 compared with 0.96 + /- 0.93 cm , p < 0.001 ) and varus-valgus orientation of the stem ( mean angle between the femur and the shaft of the prosthesis , 0.34 degrees + /- 0.67 degrees compared with 0.84 degrees + /- 1.23 degrees , p < 0.001 ) were better after the robotic procedures . At six months , slightly more heterotopic ossification was seen in the group treated with robotic implantation . The group treated with robotic implantation had a better Mayo clinical score at six and twelve months and a better Harris score at twelve months ; however , by twenty-four months , no difference was found between the groups with regard to any of the three scores . Dislocation was more frequent in the group treated with robotic implantation : it occurred in eleven of the sixty-one patients in that group compared with three of eighty in the other group ( p < 0.001 ) . Recurrent dislocation and pronounced limping were indications for revision surgery in eight of the sixty-one patients treated with robotic implantation compared with none of the seventy-eight ( excluding two with revision for infection ) treated with manual insertion ( p < 0.001 ) . Rupture of the gluteus medius tendon was observed during all of the revision operations . CONCLUSIONS The robotic-assisted technology had advantages in terms of preoperative planning and the accuracy of the intraoperative procedure . Disadvantages were the high revision rate ; the amount of muscle damage , which we believe was responsible for the higher dislocation rate ; and the longer duration of surgery . This technology must be further developed before its widespread usage can be justified Minimally invasive total hip arthroplasty ( MIS THA ) aims at minimizing damage to muscles and tendons to accelerate postoperative recovery . Computer navigation allows a precise prosthesis alignment without complete visualization of the bony l and marks during MIS THA . A r and omized controlled trial ( RCT ) was conducted to determine the effectiveness of a computer-navigated MIS anterior approach for THA compared to a conventional posterolateral THA technique on the restoration of physical functioning during recovery following surgery . Thirty-five patients underwent computer-navigated MIS THA via the anterior approach , and 40 patients underwent conventional THA using the conventional posterolateral approach .  Gait analysis was performed preoperatively , 6 weeks , and 3 and 6 months postoperatively using a body-fixed-sensor based gait analysis system . Walking speed , step length , cadence , and frontal plane angular movements of the pelvis and thorax were assessed . The same data were obtained from 30 healthy subjects . No differences were found in the recovery of spatiotemporal parameters or in angular movements of the pelvis and thorax following the computer-navigated MIS anterior approach or the conventional posterolateral approach . Although gait improved after surgery , small differences in several spatiotemporal parameters and angular movements of the trunk remained at 6 months postoperatively between both patient groups and healthy subjects Introduction : Minimally invasive surgery represents one of the most recent techniques to have emerged within THA . In conventional THA , the incision typically measures 15–20 cm . Minimal invasive approach defined as less invasive to the skin , muscles , or bone may reduce complications and improve recovery time . A number of different approaches and methods have been described in literature . Purpose : This is a prospect i ve study describing the technique and early results of the modified antero-lateral minimal invasive ( ALMI ) approach and comparing our results to the results of other investigators interested in minimal invasive THA . Material s and methods : Seventy-five consecutive primary total hip arthroplasties ( cemented and cementless ) were done through a modified ALMI approach ( 6–8 cm ) , in which we kept the hip abductors intact . Neither special instruments nor specially design ed prostheses were needed . Minimum follow-up was 12 months . Results : The mean Harris hip score for patients after 12-month follow-up was 90 while the mean Merle d’Abugine mean score was 16.5 . Both scores reached almost the maximum values within 3 months after surgery . The cup abduction angle for 70 % patients was between 35 ° and 45 ° . No femoral stem mal-alignment was recorded . The mean operative time of cemented prosthesis was 65 min while that of the cementless prosthesis was 55 min . No wound complications or dislocations were recorded . All the patients were allowed to weight bear in the second post-operative day and involved in an early rehabilitation program . Conclusion : ALMI hip approach with sparing of hip abductors is safe and gives excellent orientation for positioning of prosthesis components . It also allows early and smooth post-operative rehabilitation with fast recovery of the patient in terms of weight bearing This prospect i ve study compares a mini-incision technique and traditional posterior approach for total hip arthroplasty ( THA ) . Thirty-three patients who had undergone a mini-incision THA were matched by diagnosis , gender , average age , and preoperative Harris Hip Score ( HHS ) to 33 patients who had undergone THA using the traditional posterior approach .  The average length of the incision for group 1 was 11.7 cm ( range , 7.3 - 13.0 ) and for group 2 was 20.2 cm ( range , 14.8 - 26.0 ) . At the 3-month follow-up , patients in the mini-incision group had significant improvement in limp ( P<.05 ) and ability to climb stairs ( P < .01 ) compared with the traditional group . At the 6 month follow-up , the mini-incision group was significantly better in terms of limp ( P < .05 ) , distance walked ( P<.001 ) , and stairs ( P < 0.001 ) . There was no significant difference between groups for pain , function , or range of motion at the 1-year follow-up examination UNLABELLED While others have reported short-term comparisons between various minimally invasive surgical ( MIS ) approaches to  total hip arthroplasty ( THA ) and their conventional analogues , longer-term data is lacking , as is information indicating whether MIS approaches to THA provide a biomechanically complete recovery . Furthermore , different MIS approaches have not been compared . Our approaches of interest were a one-incision modified Watson-Jones , and a two-incision approach . HYPOTHESES ( 1 ) There are significant differences in gait recovery patterns between the two surgical groups and ( 2 ) THA subjects have significant differences in function one year after surgery compared to control subjects . To test these hypotheses , THA c and i date s ( n=26 ) were r and omized to receive one of these MIS approaches and evaluated preoperatively , and postoperatively at 3 weeks , and at 3 , 6 and 12 months . Evaluations included three-dimensional gait analysis and 24-hour step-counts . The same data were obtained from 25 control subjects .  Recovery time-course was assessed using repeated measures ANOVA . T-tests were used to compare controls with the pooled group of THA subjects . We found no differences between the two THA surgical groups regarding the time-course of recovery ( p≥0.591 ) . Although recovery was statistically complete by 3 months postoperatively for all variables , there were significant differences from controls at 12 months . Most notably , the external hip adduction moment , which reflects hip abductor function , was more than one st and ard deviation below normal ( p<0.001 ) . THA subject inactivity could not explain the gait differences , since one year after surgery daily step counts were not significantly different from controls ( p=0.346 ) . More work is necessary to determine ways to improve biomechanical outcomes for today 's patients with high expectations for function and implant longevity Surgical approaches to the hip for total hip arthroplasty ( THA ) are termed minimally invasive when allowing for a skin incision length of 10 cm or less . The aim of this study was to explore if a minimally invasive posterior approach compared to a classic anterolateral approach negatively influenced surgical time , blood loss , implant position , or perioperative complications .  Two groups of THA patients mainly differing with respect to the surgical approach were compared . Results of 76 consecutive THA via a posterior mini-incision approach were recorded prospect ively and those of 76 controls operated via a classic anterolateral approach were recorded retrospectively .  THA was performed by the same surgeon in every case . Surgical time or intraoperative blood loss were not different among the groups . Total 24-h blood loss was significantly less in patients undergoing THA via minimally invasive posterior  approaches . Median cup inclination was 45 degrees in both groups . Cup anteversion was 15 degrees ( classic anterolateral ) and 12 degrees ( minimally invasive posterior ) , respectively . Stem position was regarded as neutral in 80 % of THA through classic anterolateral and in 76 % through minimally invasive dorsal incisions . Complications occurred in 8 % ( classic anterolateral ) and 9 % ( minimally invasive posterior ) of THA patients . Surgical time , blood loss , risk of malpositioned implants , or complications were not increased for THA patients operated through minimally invasive posterior incisions compared to those operated via classic anterolateral approaches Abstract Despite the high number of total hip arthroplasty ( THA )  procedures performed each year , there is no common consensus on the best surgical approach . Gait is known to improve following THA although it does not return to what is typically quantified as normal , and surgical approach is believed to be a contributing factor . The current study evaluates post-operative hip function  and provides an objective assessment following two common surgical approaches : the McFarl and —Osborne direct lateral and the southern posterior .  Faced with the common problem of providing an objective comparison from the wealth of data collected using motion analysis techniques , the current study investigates the application of an objective classification tool to provide information on the effectiveness of each surgery and to differentiate between the characteristics of hip function following the two approaches . Seven inputs for the classifier were determined through statistical analysis of the biomechanical data . The posterior approach group exhibited greater characteristics of non-pathological gait and displayed a greater range of functional ability as compared with the lateral approach cohort . The classification tool has proved to be successful in characterizing non-pathological and THA function but was insufficient in distinguishing between the two surgical cohorts Background For total hip arthroplasty ( THA ) , minimally invasive surgery ( MIS ) uses a smaller incision and less muscle dissection than the classic approach ( CLASS ) , and may lead to faster rehabilitation . Questions / purpose sDoes minimally invasive hip arthroplasty result in superior clinical outcomes ? Patients and Methods In this double-blind r and omized controlled trial , 120 consecutive primary noncemented THAs in 120 patients were assigned to one of two groups ( MIS or CLASS ) . The r and omization sequence was stratified for two groups of surgeons , ie , those using a posterolateral approach ( PL-CLASS or PL-MIS ) and those using an anterolateral approach ( AL-CLASS or AL-MIS ) . Length of the incisions was 18 cm for the CLASS procedures . MIS incisions were extended at the skin level to 18 cm at the end of the procedure . The primary end point was the Harris hip score ( HHS ) at 6 weeks postoperatively . Patient-centered question naires were obtained preoperatively and after 6 weeks and 1 year . Results For the patients in the MIS group ( average 7.8 cm incision length ) , statistically significant increased mean HHSs were seen compared with the CLASS group at 6 weeks and 1 year . This difference was small and mainly caused by the favorable results of the PL-MIS . In the MIS group , surgical time was longer . A learning curve was observed based on operation time and complication rate . Although not statistically significant , the perioperative complication rate was rather high in the ( anterolateral ) MIS group . Conclusions The minimal invasive approach in THA did not show a clinical ly relevant superior outcome in the first postoperative year . Level of Evidence Level I , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence Abstract There have been several attempts to reduce postoperative blood loss in patients undergoing total arthroplasty . Benoni et al. reported the usefulness of tranexamic acid in total knee arthroplasty ( TKA ) . We investigated its effect in TKA and total hip arthroplasty ( THA ) . Blood loss was significantly reduced in patients given tranexamic acid  in both the TKA and THA groups , and no severe complications , such as venous or pulmonary thrombosis , were noted in any of the patients who received the agent . Administration of tranexamic acid seems to be useful for reducing postoperative blood loss in TKA and THA A comparison of pertinent preoperative and postoperative data relative to total hip resurfacing versus total hip arthroplasty ( THA ) would assist in evaluating current perceptions in outcome . We compared 50 consecutive metal-metal resurfacing replacements in 50 patients with 44 consecutive conventional total hip arthroplasties in 35 patients , who were implanted during the same time period , by the same surgeon , and followed prospect ively for 2 to 4 years . The patients undergoing hip resurfacing were 62 % male , 9 years younger , and 3.2 inches taller , with a lower mean body mass index and American Society of Anesthesiologists ( ASA ) grade than patients undergoing total hip arthroplasty .  Preoperatively , patients undergoing resurfacing had a lower Harris hip score ( 46 vs 52 points ) , more pain , higher UCLA ( University of California at Los Angeles ) activity scores ( 4.2 vs 3.6 ) , and better range of motion . Surgical time for resurfacing was 18 % longer , but there was less total blood loss and fewer transfusions . Postoperatively , there was no difference in Harris hip score ( 97 vs 96 ) . Patients undergoing resurfacing had higher function , Short Form-12 physical activity scores , and UCLA activity scores , but also a higher incidence of slight or mild pain . There were no differences in postoperative range of motion or dislocation ( one each ) . The preoperative characteristics and general health status of the average patient undergoing resurfacing are more favorable than that of the average patient undergoing conventional total hip arthroplasty . Caution should be applied in attributing differences in outcomes directly to the arthroplasty technology Abstract Metal-on-metal total hip resurfacing arthroplasty has had excellent reported results at early to midterm followup , and some studies suggest that outcomes are comparable to conventional THA . We compared the clinical and radiographic outcomes of two closely matched groups of 54 patients who underwent resurfacing and conventional THA , respectively . Each group consisted of 36 men and 18 women who had a mean age of 52 years and a mean body mass index of 29 kg/m2 . At a minimum followup of 24 months ( mean , 40 months ; range , 24–60 months ) , the mean Harris hip scores increased similarly in both groups ( from 52 to 90 points and from 50 to 91 points for the resurfacing and conventional groups , respectively ) . Radiographic outcomes , revision rates , complications , pain scores , and satisfaction ratings of the two groups were similar . The patients who underwent resurfacing had higher postoperative weighted activity scores than the patients who underwent conventional THA , although they had higher preoperative weighted activity scores as well . The early outcomes of resurfacing are comparable to those of conventional THA . Level of Evidence : Level III , therapeutic study . See the Guidelines for Authors for a complete description of levels of evidence Introduction Advantages of minimally invasive total hip arthroplasty ( THA )  are controversially discussed . Method In this prospect i ve study 51 patients ( 52 hips ) were r and omly allocated to a classical lateral or a minimally invasive approach ( modification of the Hardinge-approach ) . Operating time , intraoperative blood loss , postoperative hemoglobin , muscle enzymes CK and myoglobin were recorded . Radiologically the positioning of the prosthesis was analyzed . WOMAC- and Harris Hip Score ( HHS ) were assessed preoperatively , at discharge , at 6 weeks and 3 months . Results In the minimally invasive group there was a shorter length of surgery , the scores in the WOMAC and HHS were slightly better at discharge and at the 3 months- examination , myoglobin-rise was slightly less . The positioning of the prosthesis was good in both groups . Minimally invasive THA led to a quicker recovery , at 3 months postoperative there was still a slight difference to the st and ard group . Conclusion If these slight differences subside has to be examined in studies with a longer follow-up BACKGROUND The considerable variation in anatomical abnormalities of hip joints associated with different types of developmental dysplasia of hip ( DDH ) makes reconstruction in total hip arthroplasty ( THA ) difficult . It is desirable to create patient-specific design s for THA procedures . In the cases of adult single DDH , an accuracy-improved method has been developed for acetabular cup prosthesis implantation of hip arthroplasty . METHODS From October 2007 to November 2008 , 22 patients with single DDH ( according to the Crowe st and ard , all dysplasia hips were classified as type I ) were scanned with spiral CT pre-operatively . These patients scheduled for THA were r and omly assigned to undergo either conventional THA ( control group , n = 11 ) or navigation template implantation ( NT group , n = 11 ) . In the NT group , three-dimensional ( 3D ) CT pelvis image data were transferred to a computer workstation and 3D models of the hip were reconstructed using the Mimics software . The 3D models were then processed by the Imageware software . In brief , a template that best fitted the location and shape of the acetabular cup was ' reversely ' built from the 3D model , the rotation centre of the pathological hip determined by mirroring that of the healthy site , and a guiding hole in the template was then design ed . The navigational templates were manufactured using a rapid prototyping machine . These navigation templates guide acetabular component placement . RESULTS Based on the predetermined abduction angle 45 ° and anteversion angle 18 ° , after 1 year follow-up , the NT group showed significantly smaller differences ( 1.6 ° ± 0.4 ° , 1.9 ° ± 1.1 ° ) from the predetermined angles than those in the control group ( 5.8 ° ± 2.9 ° , 3.9 ° ± 2.5 ° ) ( P < 0.05 ) . CONCLUSIONS The template design s facilitated accurate placement of acetabular components in dysplasia of acetabulum . The hip 's center of rotation in DDH could be established using computer-aided design , which provides a useful method for the accurate location of prosthesis with a low cost-performance ratio without excessive technical workload on the surgical team Purpose . To compare outcome after  total hip arthroplasty ( THA )  through the mini-incision approach versus the st and ard transgluteal approach . Methods . 80 women and 63 men aged 33 to 89 ( mean , 62 ) years with primary osteoarthritis of the hip were r and omised to undergo unilateral THA through a mini-incision approach ( Micro-hip , n=55 ) or st and ard , lateral , transgluteal approach  ( Bauer , n=88 ) . Levels of haemoglobin , haematocrit , serum creatine kinase , and C-reactive protein , length of hospital stay , mobilisation , and any complication were recorded . Visual analogue scale ( VAS ) for pain was assessed . Hip function was assessed using the Harris Hip Score and the Oxford Hip Score , whereas general health was assessed using the EQ-5D general health question naire . The cup inclination and varus/ valgus of the stem position were measured using a goniometer . Results . The Micro-hip group achieved a significantly lower mean incision length ( 9.3 vs. 13.4 cm , p<0.001 ) , mean surgical time ( 60 vs. 68 minutes , p=0.021 ) , mean reduction in haemoglobin level ( 2.1 vs. 2.8 g/dl , p<0.001 ) , and mean VAS for pain from hour 6 to day 6 ( all p<0.05 ) . One patient in the Micro-hip group developed early aseptic loosening of the cup and underwent revision surgery at month 4 . Three patients in the Bauer group and one patient in the Micro-hip group sustained intra-operative non-displaced fractures of the proximal femur , which were fixed with cerclages . Two patients in the Micro-hip group developed deep vein thrombosis during week 1 . Conclusion . THA through the Micro-hip approach achieved faster pain relief Surgical approach for total hip arthroplasty ( THA ) is determined by clinician preference from limited prospect i ve data . This study aim ed to examine the effect of surgical approach ( direct lateral , posterior , and anterolateral ) on 6-week postoperative gait mechanics . Thirty-five patients ( direct lateral , 8 ; posterior , 12 ; anterolateral , 15 ) were tested preoperatively and 6 weeks after THA .  Patients underwent a gait analysis at a self-selected walking speed . A 2-way analysis of variance was used for analysis . Stride length , step length , peak hip extension , and walking speed increased after THA . The 3 surgical approach variables were not significantly different for any of the study variables after THA . All patients showed some increase in selected variables after THA regardless of surgical approach . In this study , surgical approach did not appear to significantly influence the early postoperative gait mechanics that were quantified
Moreover , postoperative complications ( eg , dislocation and revision surgery ) were less frequent in the CM group than in the RA group .
Conclusion Compared with the CM approach , the RA approach yields better radiological outcomes and fewer intraoperative complications in THA , but similar functional scores
Abstract Background Several studies have compared robotics‐assisted ( RA ) and conventional manual ( CM ) approaches for total hip arthroplasty ( THA ) , but their results are controversial .