The meta- analysis of the current evidence base showed that minimally invasive THA is associated with a significantly increased risk of transient lateral femoral cutaneous nerve palsy ( p = 0.006 ) with no significantly better outcome
Over the past decade , minimally invasive surgery has gained popularity as a means of optimising early postoperative rehabilitation and increasing patient satisfaction and cosmesis following  total hip arthroplasty ( THA ) .
However , this surgical exposure has also been associated with increased risk of iatrogenic nerve injury and implant mal-positioning due to limited visibility compared to conventionally larger surgical incisions .
The purpose of this meta- analysis was to compare the outcomes of these two surgical exposures .
[Prospective and comparative study of minimally invasive posterior approach versus standard posterior approach in total hip replacement].
PURPOSE OF THE STUDY There have been few prospect i ve studies comparing minimally invasive approaches for total hip replacement . We wanted to ascertain the contribution of the minimally invasive posterior approach in comparison with the st and ard posterolateral approach in terms of early outcome . MATERIAL S AND METHODS This was prospect i ve comparative consecutive series of patients . Patients with major architectural problems or undergoing revision arthroplasty were excluded . One hundred ten patients ( 116 hips ) were divided into two groups which were comparable for number of patients , gender , age , body mass index , indication for surgery , and preoperative function scores . The preoperative ASA score was lower in the minimally invasive group ( p=0.04 ) . The patients were in the lateral reclining position for the two approaches and classical instrumentation using the same implants ( stems and cemented or non-cemented cups ) were used . We noted operative time and blood loss ( using the Brecher method based on the hematocrit at day 1 and 5 and the number of blood transfusions ) , postoperative pain , and implant position . Functional outcome was assessed with the modified Harris score and the WOMAC index ( at 6 weeks and 3 and 6 months ) . Statview(R ) was used to search for statistical significance considering p<0.05 as significant . RESULTS Mean length of incision was 8.5 cm versus 15.1 cm . Mean blood loss was significantly less in the minimally invasive group ( p=0.027 ) as was the level of postoperative pain as confirmed by the lesser consumption of morphine analgesics ( p=0.006 ) . Other operative variables as well as implant position were comparable . There were no major complications in the minimally invasive group . In the st and ard group , there was one case of common peroneal nerve palsy , two dislocations , and two fractures related to falls after prosthesis implantation . The WOMAC index was better after the minimally invasive approach at six weeks and at three months ( p<0.05 ) . The modified Harris score was better only at six weeks . Functional outcome and pain became comparable thereafter . DISCUSSION AND CONCLUSION The minimally invasive posterior approach does not require an orthopedic table nor specific instrumentation . A minute procedure is required with ligature of the posteromedial circumflex artery of the thigh to improve exposure and limit intraoperative bleeding . It enables satisfactory reproducible implant positioning . Conversion to an open posterolateral approach is possible if needed . The minimally invasive posterior approach enables a reduction in intraoperative bleeding and in postoperative pain while allowing earlier more rapid rehabilitation . Early clinical outcome is better but beyond six weeks , the functional results are comparable for the two approaches . The minimally invasive posterior approach is a reliable reproducible approach with a progressive learning curve
The meta- analysis of the current evidence base showed that minimally invasive THA is associated with a significantly increased risk of transient lateral femoral cutaneous nerve palsy ( p = 0.006 ) with no significantly better outcome
Over the past decade , minimally invasive surgery has gained popularity as a means of optimising early postoperative rehabilitation and increasing patient satisfaction and cosmesis following  total hip arthroplasty ( THA ) .
However , this surgical exposure has also been associated with increased risk of iatrogenic nerve injury and implant mal-positioning due to limited visibility compared to conventionally larger surgical incisions .
The purpose of this meta- analysis was to compare the outcomes of these two surgical exposures .