[Comparison of total hip arthroplasty via a posterior mini-incision versus a classic anterolateral approach]. In-Hospital Cost Analysis of Total Hip Arthroplasty: Does Surgical Approach Matter? Objective functional assessment of total hip arthroplasty following two common surgical approaches: The posterior and direct lateral approaches Tackling the learning curve: comparison between the anterior, minimally invasive (Micro-hip®) and the lateral, transgluteal (Bauer) approach for primary total hip replacement The effect of total hip arthroplasty surgical approach on postoperative gait mechanics. Total Hip Arthroplasty through the Mini-Incision (Micro-Hip) Approach versus the Standard Transgluteal (Bauer) Approach: A Prospective, Randomised Study Leg length and offset differences above 5mm after total hip arthroplasty are associated with altered gait kinematics. Total hip arthroplasty surgical approach does not alter postoperative gait mechanics one year after surgery. Minimally Invasive versus Classic Procedures in Total Hip Arthroplasty: A Double-blind Randomized Controlled Trial 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 gait in patients following a computer-navigated minimally invasive anterior approach and a conventional posterolateral approach for total hip arthroplasty: a randomized controlled trial. Prospective randomized study of two surgical approaches for total hip arthroplasty. Reduced patient restrictions following total hip arthroplasty: study protocol for a randomized controlled trial Total Hip Arthroplasty Performed Through Direct Anterior Approach Provides Superior Early Outcome: Results of a Randomized, Prospective Study. Minimally invasive total hip arthroplasty: a randomized controlled prospective trial The effect of total hip arthroplasty surgical approach on gait. [Minimally invasive total hip arthroplasty with anterior incision]. Does the anterior approach for total hip arthroplasty better restore stair climbing gait mechanics? [Minimally invasive posterior approach for total hip arthroplasty]. Total hip arthroplasty through a minimally invasive lateral approach--our experience and early results. Effects of Tranexamic Acid on Blood Loss during Total Hip Arthroplasty Multiple boluses of intravenous tranexamic acid to reduce hidden blood loss and the inflammatory response following enhancedrecovery primary total hip arthroplasty: A RANDOMISED CLINICAL TRIAL A regime of two intravenous injections of tranexamic acid reduces blood loss in minimally invasive total hip arthroplasty: a prospective randomised double-blind study. Reduction of blood loss using tranexamic acid in total knee and hip arthroplasties Antero-lateral minimal invasive (ALMI) approach for total hip arthroplasty technique and early results Does the Dual-Mobility Hip Prosthesis Produce Better Joint Kinematics During Extreme Hip Flexion Task? Patient’s perspective on direct anterior versus posterior approach total hip arthroplasty Hip external rotator exercise contributes to improving physical functions in the early stage after total hip arthroplasty using an anterolateral approach: a randomized controlled trial Patient-reported outcome after total hip arthroplasty: comparison between lateral and posterior approach
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 The purpose s of this study were to determine the impact of surgical approach on costs of  total hip arthroplasty ( THA )  from a hospital perspective and to provide an up date d cost estimation of THA . A prospect i ve , microcosting analysis was performed on 118 patients undergoing a THA through an anterior , lateral , or posterior approach .  We determined that overall costs ( intraoperative costs and hospital stay ) were significantly less for the anterior ( $ 7300.22 ; 95 % confidence interval [ CI ] , 7064.49 - 7535.95 ) vs lateral ( $ 7853.10 ; 95 % CI , 7577.29 - 8128.91 ; P = .031 ) and anterior vs posterior approach ( $ 8287.46 ; 95 % CI , 7906.42 - 8668.51 ; P < .001 ) . A reduction in hospital length of stay when THA was performed through an anterior approach contributed significantly to an overall reduction in costs from a hospital perspective 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 and purpose There is still conflicting evidence about the true benefit of minimally invasive ( MI ) techniques in total hip replacement ( THR ) . The aim of this prospect i ve study was to evaluate the safeness of a MI approach during the learning curve of a single surgeon . Second , clinical and radiographic results among the  MI THR group were compared with the results using a st and ard transgluteal ( Bauer ) approach . Methods 86 primary unilateral total hip arthroplasties ( THAs ) through a MI , anterior ( Micro-hip ® ) approach were performed by a single senior surgeon ( ES ) , representing a consecutive series of patients after beginning with the MI technique . Cases were compared to a matched cohort of patients who were treated with a st and ard transgluteal ( Bauer ) approach .  Operation time , incision length , perioperative blood loss , haemoglobin level and blood transfusions were monitored . Complications were documented and followed up 1 year postoperatively . The Harris Hip Score ( HHS ) , range of motion , use of analgetics , the Trendelenburg sign , sensibility of the lateral femoral cutaneous nerve and the acetabular/femoral component placement as well as potential heterotopic ossifications were analysed in both the groups after 12 months postoperatively . Results 74 MI THR patients and 60 st and ard THR patients were available for the one year follow-up . Operative time was significantly longer in the MI group , reduction in the haemoglobin level during the first 24 h was significant and the length of skin incision was significantly shorter . No significant differences were found for HHS , range of motion , use of analgetics , the Trendelenburg sign , and the acetabular/femoral component placement , heterotopic ossifications and intra- and postoperative complications . Sensibility of the lateral femoral cutaneous nerve was affected in three patients in the MI group . Radiographic evaluation revealed no component migration , implant subsidence or radiolucency signs in both the groups . DicussionConsistent with recent meta- analysis we found reduced blood loss , similar clinical /radiographic outcome and similar complication rates compared to st and ard THA . Our study shows , that MI THR is a safe procedure during the learning curve of an experienced surgeon 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 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 We aim ed to investigate the relationship between postoperative leg length/offset ( LL/OS ) reconstruction and gait performance after  total hip arthroplasty ( THA ) . In the course of a prospect i ve r and omized controlled trial , 60 patients with unilateral hip arthrosis received cementless THA  through a minimally-invasive anterolateral surgical approach . One year post-operatively , LL and global OS restoration were analyzed and compared to the contralateral hip on AP pelvic radiographs . The combined postoperative limb length/OS reconstruction of the operated hip was categorized as restored ( within 5 mm ) or non-restored ( more than 5 mm reduction or more than 5 mm increment ) . The acetabular component inclination , anteversion and femoral component anteversion were evaluated using CT scans of the pelvis and the femur . 3D gait analysis of the lower extremity and patient related outcome measures ( HHS , HOOS , EQ-5D ) were obtained pre-operatively , six months and twelve months post-operatively by an observer blinded to radiographic results . Component position of cup and stem was comparable between the restored and non-restored group . Combined LL and OS restoration within 5 mm result ed in higher Froude number ( p<0.001 ) , normalized walking speed ( p<0.001 ) and hip range-of-motion ( ROM ) ( p=0.004 ) during gait twelve months postoperatively , whereas gait symmetry was comparable regardless of LL and OS reconstruction at both examinations . Clinical scores did not show any relevant association between the accuracy of LL or OS reconstruction and gait six/twelve months after THA . In summary , postoperative LL/OS discrepancies larger than 5 mm relate to unphysiological gait kinematics within the first year after THA . DRKS00000739 , German Clinical Trials Register OBJECTIVE To investigate the differences in gait biomechanics on the basis of surgical approach 1 year after surgery .  DESIGN This was a descriptive laboratory study to investigate the side-to-side differences in walking mechanics at a self-selected walking speed as well as a functional assessment 1 year after total hip arthroplasty ( THA ) .  Temporospatial , kinetic , and kinematic data as well as functional outcomes were collected . Two-way analysis of variance was used to assess for between-group differences and limb-to-limb asymmetries . SETTING A controlled laboratory study . PARTICIPANTS This study examined 35 patients with primary , unilateral THA . The THA surgical approaches that were used in these patients included 12 direct lateral , 18 posterior , and 11 anterolateral . All the patients were assessed 1 year after THA . Patients were excluded from the study if they had contralateral hip pain or pathology , or any prior lower extremity total joint replacements . MAIN OUTCOME MEASUREMENTS Three-dimensional lower extremity kinematics and kinetics as well as spatiotemporal variables were collected . In addition , a series of physical performance measures were collected . RESULTS No main effects for the physical performance measures or biomechanical variables were observed among the approach groups . Significant limb-to-limb asymmetries were observed among all the patients , with decreased sagittal plane range of motion , peak extension , and peak vertical ground reaction forces on the operative side . CONCLUSION The results of this study indicated that no significant differences existed among the different surgical approach groups for any study variable . However , 1 year after THA , the patients demonstrated asymmetric gait patterns regardless of surgical approach , which indicated the potential need for continued intervention through physical therapy to regain normal side-to-side symmetry after THA 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 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 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 The benefits of different surgical approaches for total hip arthroplasty continue to be debated . One hundred patients were prospect ively enrolled and r and omized into 2 groups . One group underwent total hip arthroplasty through a single-incision modified Smith-Peterson approach , whereas the other group  underwent total hip arthroplasty through a direct lateral approach . All patients received the same postoperative protocol . Evaluation included operative time , estimated blood loss , analgesia requirement , transfusions , and length of stay . Functional outcome was assessed preoperatively and postoperatively . Up to 1-year follow-up , the direct anterior group demonstrated significantly better improvement in both the mental and physical health dimensions of Short Form-36 and Western Ontario McMaster Osteoarthritis Index compared with direct lateral approach group . At 2 years , the results in both groups were the same Background Total hip arthroplasty ( THA ) is a very common procedure in orthopedic surgery . In the Netherl and s , 25,642 primary THAs were performed in 2013 . Postoperative hip dislocation is one of the major complications and has been reported in 0.5 to 10.6 % of patients after primary THA.Several reports regarding the use of an anterolateral surgical approach have shown that a non-restriction or reduced restriction protocol does not increase the dislocation rate . For the posterolateral surgical approach it has been suggested that patient restrictions might be unnecessary but the amount of available literature is scarce . As such , r and omized controlled trials aim ed at investigating restrictions following THA using a posterior approach are strongly recommended . The aim of this prospect i ve r and omized controlled trial is to investigate the non-inferiority hypothesis concerning the early dislocation rate after THA in patients with and without the use of a reduced restriction protocol . Methods / Design After providing informed consent a group of 456 patients with symptomatic coxarthrosis will be r and omized to receive a THA either with care as usual , i.e. receiving postoperative restrictions including the advice to sleep in a supine position for the first 8 weeks postoperatively , or reduced restrictions with no recommendations regarding the position during sleeping . Primary outcome measure will be the percentage of early dislocations within the first 8 weeks after THA . Secondary outcome measures will be patient satisfaction , time to functional recovery , quality of sleep and patient ’s self-reported compliance with postoperative instructions . Discussion To our knowledge this will be the first r and omized controlled trial that compares a reduced restriction protocol with a restricted protocol following THA using a posterolateral surgical approach . Our hypothesis is that a reduced restriction protocol following THA with use of a posterolateral surgical approach has no influence on the early dislocation rate compared to a restricted protocol . Instead , embracing a reduced restriction protocol might even contribute to a higher quality of sleep , thereby facilitating a faster uptake and return to daily functions in patients after THA.Trial registration Clinical Trials.gov NCT02107248 , registration date 3 April 2014 Studies suggest that  total hip arthroplasty ( THA )  performed through direct anterior ( DA ) approach has better functional outcomes than other surgical approaches . The immediate to very early outcomes of DA THA are not known . A prospect i ve , r and omized study examined the very early outcome of THA performed through DA versus direct lateral approach . The functional outcomes on day 1 , day 2 , week 6 , week 12 , 6 months , and 1 year were measured . Patients receiving DA THA  had significantly higher functional scores during the early period following surgery . The difference in functional scores leveled out at 6 months 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 This study examined the effect of the surgical approach used in  total hip arthroplasty ( THA )  on gait mechanics six months following surgery . Quantitative gait analysis was performed on 29 subjects : 10 anterolateral ( A-L ) and 10 posterolateral ( P-L ) THA patients and nine able-bodied , velocity-matched subjects . Discriminant function analysis was used to determine the distinction of the groups with respect to sagittal plane hip range of motion , index of symmetry , trunk inclination , pelvic drop , hip abduction , and foot progression angles . The A-L group had the largest trunk inclination ( 3.0+/-2.4 degrees ) and the smallest hip range of motion ( 34.0+/-7.4 degrees ) . Both THA groups demonstrated greater asymmetry as expressed by the smaller symmetry index ( 0.97+/-0.04 for A-L and 0.98+/-0.05 for the P-L ) than the able-bodied group ( 0.99+/-0.01 ) . The classification procedure correctly classified 89 % of the control group cases , 90 % of the A-L cases , and 50 % of the P-L cases . These results support the conclusion that six months following surgery , the gait of the majority ( 85 % ) of THA patients has not returned to normal . The A-L patients displayed distinct gait patterns , while a small percentage ( 30 % ) of the P-L patients demonstrated normal gait . While these differences are statistically significant , the clinical significance is unknown and linked to the duration that they persist OBJECTIVE To report the clinical outcome of minimally invasive total hip arthroplasty  with anterior incision . METHODS One hundred and twenty cases were r and omly divided into two groups . Sixty cases ( group 1 ) who had undergone a mini-invasive THA  were compared with 60 cases ( group 2 ) who had undergone THA with st and ard posterolateral incision .  The operation time , length of incision , blood loss , anteversion angle of acetabulum cup , Harris score and complications were observed . RESULT The average operation time was almost the same ; The average length of incision for group 1 was 7.9 cm ( 7.4 - 9.0 cm ) and 16.3 cm ( 14 - 22 cm ) for group 2 ( P < 0.01 ) . The average blood loss for group 1 was 350 ml ( 250 - 530 ml ) and 650 ml ( 400 - 1200 ml ) for group 2 , there was significant difference between two groups ( P < 0.05 ) . According to the postoperative X-ray , the mean anteversion angles of cup were 24 degrees ( 19 degrees - 27 degrees ) for group 1 and 19 degrees ( 15 degrees - 22 degrees ) for group 2 . The average length of post-operative hospital stay was 7 days ( 5 - 8 days ) in group 1 and 13.5 days ( 12 - 16 days ) in group 2 ( P < 0.05 ) . The Harris score of group 1 was 91.4 ( 67 - 94 ) and 78.5 ( 67 - 91 ) for group 2 at the 3 month follow-up ( P < 0.05 ) . At the last follow up , there were no significant difference ( P > 0.05 ) , but the average ROM of group 1 were definitely more greater than that of group 2 ( 110.0 degrees + /- 3.2 degrees vs. 90.0 degrees + /- 2.9 degrees P < 0.05 ) . There was 1 case of cup reinsertion in group 1 because of large anteversion angle ; 2 cases of symptomatic DVT and 1 case of lethargy because of cerebral infa rct ion happened in group 2 . CONCLUSIONS Minimally invasive total hip arthroplasty using anterior approach is a safe and effective technique with the advantages of less soft tissue damage and less blood loss While total hip arthroplasty ( THA ) provides pain relief and restores mobility , gait anomalies persist even years after surgery . A muscle sparing surgical approach could result in better postoperative gait mechanics . Our purpose was to compare both the anterior muscle sparing approach and the direct lateral approach ( LAT ) to a matched control group by using three-dimensional motion analysis while performing stair ascent and descent tasks . Lower-limb kinematics and kinetics were recorded for 20 patients that had an anterior approach ( ANT ) , 20 that had a LAT , and 20 age- and weight-matched control participants . Patients were assessed on average 10 months after surgery . Compared to the control group , during stair ascent , the anterior group had reduced peak hip extension , peak hip flexion moment , and peak hip power . The lateral group had reduced peak hip abduction , hip frontal plane range of motion , and peak hip internal rotation . In stair descent , the anterior group had reduced peak hip flexion , peak hip abduction moment and internal rotation , as well as peak hip power . The lateral group had reduced peak hip flexion , peak knee extension moment , and peak hip power . Therefore , gait anomalies persist after THA for both approaches , which could be due to other factors such as preoperative gait adaptations The mini-posterior approach for total hip arthroplasty ( THA )  belongs to the mini-incision approaches . In comparison to st and ard approaches , less muscle trauma result ing in less pain , less blood loss and faster rehabilitation in the early postoperative period are attributed to this approach , as known for all other minimally invasive approaches . In a prospect i ve study of 100 cases of THA it could be shown that this is true when comparing the mini-posterior approach with the posterolateral approach . Lower levels of muscle enzymes as a parameter for muscle trauma , could not be seen BACKGROUND AIMS Evaluation of : 1 . early clinical and radiographic results of  total hip arthroplasty ( THA ) through a st and ard lateral direct approach , 2 . early clinical and radiographic results of THA through a minimal lateral approach , 3 . comparison of the results of THA in these two groups . MATERIAL AND METHODS 120 THAs ( 60 cementless and 60 cemented ) done in 120 patients due to degenerative changes were evaluated prospect ively . 60 THAs were done through a minimal lateral approach and constituted a study group . 60 THAs were done through a direct lateral approach and constituted a control group . The mean age of the 120 patients ( 98 women and 22 men ) was 45 y.o . ( range : 32 - 67 y.o . ) . The duration of follow-up in the study group was from 6 to 12 months ( mean : 8.5 months ) . The duration of follow-up in the control group was from 10 to 16 months ( mean : 10.5 months ) . Mean preoperative functional status of the study group was 44.5 points according to the Harris hip score . Radiographic evaluation of the results was done according to the criteria of the Joint Committee of the Hip Society , AAOS and SICOT . RESULTS 6 months after THA , clinical results were 92 pts in the study group and 88 pts in the control group . Radiographic outcomes were very good in all 120 patients from both arms : there were no differences between the control and study group . The incidence of complications was similar in both groups . CONCLUSIONS Minimally invasive THA demonstrated its value in the treatment of  degenerative changes of the hip joint  with regard to short-term outcomes . The clinical and radiographic outcomes were comparable between the st and ard and minimally invasive approaches . Success with THA using a minimally invasive approach depends on excellent operative technique and experience with st and ard hip approaches rather than on the use of special instruments Purpose . To assess the effects of tranexamic acid ( TA ) in patients undergoing total hip arthroplasty ( THA ) for osteoarthritis . Methods . 42 patients underwent primary THA for osteoarthritis by a single surgeon . 10 men and 11 women who did not receive TA were controls , whereas 9 men and 12 women who received TA constituted the treatment group . Both groups were matched for age , gender , body mass index , and American Society of Anesthesiologists grading . The type of prosthesis used ( cemented or uncemented ) was based on the surgeon 's preference and patient age , activity level and dem and s. No hybrid prosthesis was used . 10 minutes prior to incision , a single dose of intravenous TA ( 10 mg per kg body weight ) was given to patients in the treatment group . Comparison was made between both groups with regard to intra-operative blood loss , postoperative reduction in haemoglobin and haematocrit levels , blood transfusion , incidence of deep vein thrombosis , and the length of hospital stay . Results . The mean intra-operative blood loss ( 489±281 vs. 339±184 ml , p=0.048 ) and the decrease in haemoglobin level ( 38±12 vs. 29±10 g/l , p=0.014 ) were significantly higher in the control than the treatment group . Two patients among the controls received a transfusion , compared to none in the TA group ( p=0.49 , Fisher 's exact test ) . The 2 patients who needed blood transfusion had blood losses of 600 and 690 ml , compared to a mean of 489 ml in the whole group . No patient in either group developed deep vein thrombosis or pulmonary embolism up to 3 months . Conclusion . A single dose of intravenous TA ( 10 mg per kg body weight ) given 10 minutes prior to THA is a cost-effective and safe means of minimising blood loss and reduction in haemoglobin concentrations as well as the need for allogenic blood transfusion , without increasing the risk of thromboembolic events Aims The aim of this study was to examine the efficacy and safety of multiple boluses of intravenous ( IV ) tranexamic acid ( TXA ) on the hidden blood loss ( HBL ) and inflammatory  response following primary total hip arthroplasty ( THA ) . Patients and Methods A total of 150 patients were allocated r and omly to receive a single bolus of 20 mg/kg IV TXA before the incision ( group A ) , a single bolus followed by a second bolus of 1 g IV‐TXA three hours later ( group B ) or a single bolus followed by two boluses of 1 g IV‐TXA three and six hours later ( group C ) . All patients were treated using a st and ard peri‐operative enhanced recovery protocol . Primary outcomes were HBL and the level of haemoglobin ( Hb ) as well as the levels of C‐reactive protein ( CRP ) and interleukin‐6 ( IL‐6 ) as markers of inflammation . Secondary outcomes included the length of stay in hospital and the incidence of venous thromboembolism ( VTE ) . Results The mean HBL was significantly lower in group C ( 402.13 ml st and ard deviation ( sd ) 225.97 ) than group A ( 679.28 ml sd 277.16 , p < 0.001 ) or B ( 560.62 ml sd 295.22 , p = 0.010 ) . The decrease in the level of Hb between the pre‐operative baseline and the level on the third post‐operative day was 30.82 g/L ( sd 6.31 g/L ) in group A , 27.16 g/L ( sd 6.83 ) in group B and 21.98 g/L ( sd 3.72 ) in group C. This decrease differed significantly among the three groups ( p < 0.01 ) . The mean level of CRP was significantly lower in group C than in the other two groups on the second ( p ≤ 0.034 ) and third post‐operative days ( p ≤ 0.014 ) . The levels of IL‐6 were significantly lower in group C than group A on the first three post‐operative days ( p = 0.023 ) . The mean length of stay was significantly lower in group C than group A ( p = 0.023 ) . No VTE or other adverse events occurred . Conclusion Multiple boluses of IV‐TXA can effectively reduce HBL following primary THA . A regime of three boluses leads to a smaller decrease in the level of Hb , less post‐operative inflammation and a shorter length of stay in hospital than a single bolus Tranexamic acid ( TXA ) , an inhibitor of fibrinolysis , reduces blood loss after total knee arthroplasty . However , its effect on minimally invasive total hip arthroplasty ( THA ) is not clear . We performed a prospect i ve , r and omised double-blind study to evaluate the effect of two intravenous injections of TXA on blood loss in patients undergoing minimally invasive THA . In total , 60 patients ( 35 women and 25 men with a mean age of 58.1 years ; 17 to 84 ) who underwent unilateral minimally invasive uncemented THA were r and omly divided into the study group ( 30 patients , 20 women and ten men with a mean age of 56.5 years ; 17 to 79 ) that received two intravenous injections 1 g of TXA pre- and post-operatively ( TXA group ) , and a placebo  group ( 30 patients , 15 women and 15 men with a mean age of 59.5 years ; 23 to 84 ) . We compared the peri-operative blood loss of the two groups . Actual blood loss was calculated from the maximum reduction in the level of haemoglobin . All patients were followed clinical ly for the presence of venous thromboembolism . The TXA group had a lower mean intra-operative blood loss of 441 ml ( 150 to 800 ) versus 615 ml ( 50 to 1580 ) in the placebo ( p = 0.044 ) , lower mean post-operative blood loss ( 285 ml ( 120 to 570 ) versus 392 ml ( 126 to 660 ) ( p = 0.002 ) , lower mean total blood loss ( 1070 ml ( 688 to 1478 ) versus 1337 ml ( 495 to 2238 ) ( p = 0.004 ) and lower requirement for transfusion ( p = 0.021 ) . No patients in either group had symptoms of venous thromboembolism or wound complications . This prospect i ve , r and omised controlled study showed that a regimen of two intravenous injections of 1 g TXA is effective for blood conservation after minimally invasive THA 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 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 BACKGROUND  Total hip arthroplasty ( THA )  using dual-mobility ( DM ) design permits larger hip range of motion . However , it is unclear how it benefits the patients during activities of daily living . The purpose was to compare kinematic variables of the operated limb between  THA patients using either DM or single-bearing ( SB ) implants during a squat task . METHODS Twenty-four THA patients were r and omly assigned to either a DM or SB implant and matched to 12 healthy controls ( CTRLs ) . They underwent 3-dimensional squat motion analysis  before and 9 months after surgery . Sagittal and frontal plane angles of the pelvis and the hip were analyzed using statistical parametric mapping . Paired analyses compared presurgery and postsurgery squat depth . RESULTS Peak sagittal pelvis angle of DM was closer to normal compared with that of SB . Both implant groups had similar hip angle patterns and magnitude but significantly lower than the CTRLs . SB reached a much large hip abduction compared with the other groups . Both surgical groups had significantly worst squat depth than the CTRLs . CONCLUSION Neither THA implant groups were able to return pelvis and hip kinematics to the level of CTRLs . The deficit of DM implants at the pelvis combined with the poorer functional scores should caution clinicians to use this implant design in active patients . SB design causes a larger hip abduction to reach their maximum squat depth . Post-THA rehabilitation should focus on improving joint range of motion and strength Purpose Total hip arthroplasty approach comparison focused on patient ’s perspective . The direct anterior approach ( DAA ) has gained immense popularity in the last decade and is widely advocated as a superior approach in terms of quicker recovery and better overall outcome . However , the question if the level of DAA promotion is justified seems to be rarely posed . Methods A single-surgeon consecutive series of patients who underwent bilateral THA , one in DAA and the other in posterior approach ( PA ) .  The same implant design and same component sizes were used for the both sides . All the operations were performed by a single surgeon under the same pre- and post-operative care protocol . Results Twenty-one patients underwent bilateral THA , mean age 60.09 years .  Oxford Hip Score ( OHS ) was used for functional outcome assessment . There were no statistically significant differences between two approaches in terms of functional outcome ( mean OHS for DAA series was 42.95 and that for the PA was 43.38 , p 0.07 at an alpha level of 0.05 ) . Fifteen patients gave the advantage to PA , and six patients favoured DAA . Conclusion By study design , we tried to reduce the biases and acquire approach appraisal from patient ’s perspective . We anticipated the outcome in favour of DAA , but the results favoring PA came as a surprise . Future prospect i ve r and omized studies on evaluation of DAA and other approaches not only from surgeon ’s or industry ’s point of view , performed on a larger and more uniform groups , are warranted to further explore the subjective differences between DAA and PA Abstract Purpose : The purpose of this study was to investigate the effects of an exercise program focusing on hip external rotator muscle on physical recovery in the early post-operative period of total hip arthroplasty ( THA ) . Methods : Patients who underwent THA were r and omized to an exercise group ( n = 14 ) or a control group ( n = 14 ) . In exercise group , the hip external rotator exercise program was performed 5 times per week for four weeks . Outcome measures were hip pain , hip range of motion , muscle strength of lower extremity and Timed Up and Go ( TUG ) test . Results : Both the hip abductor strength ( effect size = 0.60 ) and TUG test ( effect size= −0.53 ) in the exercise group improved significantly after the intervention . Conclusions : The results of the present study demonstrated that exercise program focusing on hip external rotator muscle was an effective intervention , especially in improving both hip abductor strength and walking ability in the acute post-THA stage . Implication for Rehabilitation After THA , in order to safely progress patients back to their desired activity level , there is a need to develop rehabilitation strategies to expedite and promote the recovery during the acute postoperative period . Exercise program focusing on hip external rotator muscle may lead to significant improvement of hip abductor muscle strength and gait ability in the acute post-THA stage Background and purpose — Criticism of the lateral approach ( LA ) for hip arthroplasty is mainly based on the risk of poor patient-reported outcomes compared to the posterior approach ( PA ) . However , there have been no controlled studies comparing patient-reported outcomes between them . In this r and omized controlled trial , we tested the hypothesis that patient-reported outcomes are better in patients who have undergone total hip arthroplasty ( THA ) with PA  than in those who have undergone THA with LA , 12 months postoperatively . Patients and methods — 80 patients with hip osteoarthritis ( mean age 61 years ) were r and omized to THA  using  PA or the modified direct LA . We recorded outcome measures preoperatively and 3 , 6 , and 12 months postoperatively using the Hip Disability and Osteoarthritis Outcome Score – Physical Function Short Form ( HOOS-PS ) as the primary outcome . Secondary outcomes were HOOS-Pain , HOOS- Quality -Of-Life , EQ-5D , UCLA Activity Score , and limping . Results — We found no statistically significant difference in the improvements in HOOS-PS between the treatment groups at 12-month follow-up . All secondary outcomes showed similar results except for limping , where PA patients improved significantly more than LA patients . Interpretation — Contrary to our hypothesis , patients treated with PA did not improve more than patients treated with LA regarding physical function , pain , physical activity , and quality of life 12 months postoperatively . However , limping was more pronounced in the LA patients
The posterolateral approach reported the lowest value for the surgical duration .
The posterolateral approach reported the shortest hospitalization length .
The posterolateral approach reported shorter surgical duration and hospitalization length .
Concerning the analysis of total estimated blood loss , no significant result was obtained .
Despite the numerous studies , there is no consensus concerning the best approach for  total hip arthroplasty ( THA )  , and debates are ongoing .
The purpose of this study was to perform a Bayesian network meta- analysis ( NMA ) comparing several approaches for primary THA .
The focus was on peri-operative outcomes : surgical duration , total estimated blood loss , and length of the hospitalization .