Division of Lower Limb Reconstruction and Oncology, Department of Orthopaedics, University of British Columbia, Room 3114, 910 West 10th Avenue, Vancouver, BC, V5Z 4E3, Canada.
Clin Orthop Relat Res. 2013 Feb;471(2):463-71. doi: 10.1007/s11999-012-2603-1.
There has been considerable interest in minimally invasive surgical (MIS) THA in recent years. The MIS anterolateral approach, or the MIS Watson-Jones approach, is a novel intermuscular abductor-sparing technique. Early reports from case series suggest the potential for superior function and reduced complications; however, the available information from clinical reports is inadequate to suggest surgeons should change from their accepted standard approach.
QUESTIONS/PURPOSES: We examined the potential superiority of this anterolateral approach, as judged by quality-of-life (QoL) measures, radiographic parameters, and complications, compared to limited-incision MIS direct lateral and MIS posterolateral approaches.
We performed a prospective randomized controlled trial involving five surgeons at three centers, recruiting 156 patients undergoing primary THA to receive either the MIS anterolateral or the surgeon's preferred approach (direct lateral or posterolateral). For the 135 patients we report, we collected patient-reported WOMAC, SF-36, Paper Adaptive Test in 5 Domains of Quality of Life in Arthritis Questionnaire [PAT5D], and patient satisfaction scores. We recorded complications and evaluated radiographs for prosthetic component position, subsidence, and fracture. Minimum followup was 24 months (mean, 30 months; range, 24-42 months).
QoL and patient-reported satisfaction were similar between groups. Radiographic evaluation demonstrated no differences in acetabular component positioning; however, mean stem subsidence was 4.6 mm for the MIS anterolateral group and 4.1 mm for the alternate group, with differences observed among the three centers for stem subsidence and fracture. One center had increased rate of fracture requiring treatment and need for revision in the MIS anterolateral group.
We found no superiority of the MIS anterolateral approach but observed intersite differences in painful stem subsidence and fracture. We have returned to the standard surgical approaches in use before the trial.
Level I, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
近年来，微创外科（MIS）THA 受到了广泛关注。MIS 前外侧入路，或 MIS Watson-Jones 入路，是一种新的肌间外展肌保留技术。来自病例系列的早期报告表明，该技术具有更好的功能和更低的并发症风险；然而，来自临床报告的现有信息还不足以表明外科医生应该改变他们目前认可的标准入路。
问题/目的：我们通过生活质量（QoL）测量、影像学参数和并发症，检查了这种前外侧入路相对于有限切口 MIS 直接外侧入路和 MIS 后外侧入路的潜在优势。
我们进行了一项前瞻性随机对照试验，涉及三个中心的五名外科医生，招募了 156 名接受初次 THA 的患者，分别接受 MIS 前外侧入路或外科医生首选的入路（直接外侧或后外侧）。对于我们报告的 135 名患者，我们收集了患者报告的 WOMAC、SF-36、关节炎患者生活质量的 5 个领域的纸张自适应测试问卷（PAT5D）和患者满意度评分。我们记录了并发症，并评估了假体组件位置、下沉和骨折的影像学。最小随访时间为 24 个月（平均 30 个月；范围 24-42 个月）。
两组患者的 QoL 和患者报告的满意度相似。影像学评估显示髋臼组件位置无差异；然而，MIS 前外侧组的平均股骨柄下沉为 4.6mm，其他组为 4.1mm，三个中心之间存在股骨柄下沉和骨折的差异。一个中心的 MIS 前外侧组出现了更高的骨折发生率，需要治疗和翻修。
我们没有发现 MIS 前外侧入路的优势，但观察到不同站点之间在疼痛性股骨柄下沉和骨折方面存在差异。我们已经回到了试验前使用的标准手术入路。
I 级，治疗性研究。有关证据水平的完整描述，请参见作者说明。
