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Minimally Invasive Compared with Traditional Transgluteal Approach for Total Hip ArthroplastyA Comparative Gait Analysis
M. Pospischill, MD1; A. Kranzl, Mag1; B. Attwenger1; K. Knahr, MD1
1 Department II (M.P. and K.K.) and Laboratory of Gait and Human Movement (A.K. and B.A.), Orthopedic Hospital Vienna—Speising, Speisingerstrasse 109, A-1130 Vienna, Austria. E-mail address for M. Pospischill: martin.pospischill@oss.at. E-mail address for A. Kranzl: andreas.kranzl@oss.at. E-mail address for B. Attwenger: bernhard.attwenger@oss.at. E-mail address for K. Knahr: karl.knahr@oss.at
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. 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.

Investigation performed at the Orthopedic Hospital Vienna—Speising, Vienna, Austria

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Feb 01;92(2):328-337. doi: 10.2106/JBJS.H.01086
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Abstract

Background: 

Minimally invasive total hip arthroplasty is purported to allow an improved and faster rehabilitation in the immediate postoperative period because of reduced soft-tissue damage compared with total hip arthroplasty performed with use of a standard approach. In the present study, a minimally invasive approach was compared with a traditional standard approach in terms of the effect on gait kinematics as demonstrated with gait analysis and electromyography.

Methods: 

Twenty randomized patients who underwent a primary total hip replacement with use of a minimally invasive modified Watson-Jones approach (minimally invasive group) were compared with a group of twenty patients who underwent a total hip arthroplasty with use of a standard transgluteal Hardinge approach (standard group). All patients received the same cementless implant, inserted with use of standard instruments, and all operations were performed by a single, experienced surgeon. The patients were evaluated with use of three-dimensional gait analysis and dynamic electromyograms at three time points: preoperatively, ten days postoperatively, and twelve weeks postoperatively. Temporospatial and joint-kinematic parameters were evaluated.

Results: 

There were no significant differences between the two groups with regard to the temporospatial variables of velocity, cadence, step length, and stride length at any tested time point. With regard to the range of motion of the operatively treated hip, the minimally invasive group had a smaller decrease at the ten-day time point in comparison with the standard group. However, this finding was not significant. The reduction in the range of motion was mainly caused by reduced hip extension. A compensatory increase in the pelvic tilt was observed in both groups. One patient in the standard group showed a positive Trendelenburg gait ten days postoperatively; it had disappeared completely at the twelve-week time point.

Conclusions: 

With regard to gait kinematics in the early postoperative period (three months), the present study showed no significant benefit for patients who underwent a total hip arthroplasty through a minimally invasive Watson-Jones approach in comparison with those who were managed with a standard transgluteal approach.

Level of Evidence: 

Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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