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What's the difference between a standard open incision and new mini incision for hip replacement?

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Q: You will probably recognize me because I have visited your website before and asked several questions. You have always been helpful, so I hope you won't mind one more question. How do I compare having a hip replacement with the new mini-incision versus the standard open incision? The surgeon I am seeing offers both. I get to make the final decision.

A: Your question comes at a good time with the recent publication of a study conducted at the Health Services Research Unit at the University of Aberdeen in Scotland. They conducted a very thorough electronic literature search on-line for any and all studies comparing the results of a mini-incision approach to hip replacement to the results using a standard incision.

More and more hip replacements are being performed with a mini-incision (less than 10 centimeters or two and a half inches long). Surgeons need to know what evidence there is to favor this approach when advising patients which way to go (mini-incision versus traditional open surgery). What they found may be helpful to you in your discussions with the surgeon.

There were 15 studies that met the eligibility requirements for good quality studies with a total of 1857 patients (when all combined together). Outcomes were compared by looking at amount of blood lost, length of operative time, number of days in the hospital, and complication rate. Complications included dislocations after surgery, level of pain, excessive blood loss, nerve injury, infection, fractures, blood clots, and the need for a second (revision) surgery.

Analysis of all the data showed that there were small differences in early results but in the end, no major differences in outcomes between the two groups. Sure, there was a bit less blood lost during the mini-incision procedures and the hospital stay was a day or two shorter. But there were no significant differences between the two groups when looking at complications or revision rates.

The authors point out the fact that the available studies were all fairly short-term. So long-term results cannot be compared at this time. Without the benefit of 10 to 20 year studies, it's not clear if the mini-incision approach provides any major advantages over the traditional standard-incision surgery. The authors of the study summarize it well in a single statement: Current evidence is not strong enough to support one surgical technique over the other.

Reference: Mari Imamura, PhD, et al. Single Mini-Incision Total Hip Replacement for the Management of Arthritic Disease of the Hip. In The Journal of Bone and Joint Surgery. October 17, 2012. Vol. 94-A. No. 20. Pp. 1897-1905.

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