[Advantages of minimal invasive total hip replacement in the early phase of rehabilitation]. Antero-lateral minimal invasive (ALMI) approach for total hip arthroplasty technique and early results Minimally Invasive versus Classic Procedures in Total Hip Arthroplasty: A Double-blind Randomized Controlled Trial Minimally invasive compared with traditional transgluteal approach for total hip arthroplasty: a comparative gait analysis. A randomized, prospective study of 3 minimally invasive surgical approaches in total hip arthroplasty: comprehensive gait analysis. Minimally invasive total hip arthroplasty: a randomized controlled prospective trial Minimally-invasive total hip arthroplasty will improve early postoperative outcomes: a prospective, randomized, controlled trial Minimally invasive total hip arthroplasty--our clinical experience. Enhanced early outcomes with the anterior supine intermuscular approach in primary total hip arthroplasty. A lateral minimal-incision technique in total hip replacement: a prospective, randomizes, controlled trial. The impact of minimally invasive total hip arthroplasty on the standard procedure [Prospective and comparative study of minimally invasive posterior approach versus standard posterior approach in total hip replacement]. Anterolateral mini-invasive versus posterior mini-invasive approach for primary total hip replacement. Comparison of exposure and implant positioning The use of computer navigation in performing minimally invasive surgery for intertrochanteric hip fractures--The experience in Singapore. Minimal-invasive posterior approach for total hip arthroplasty versus standard lateral approach. [Minimally invasive posterior approach for total hip arthroplasty]. Anterolateral minimally invasive total hip arthroplasty: a prospective randomized controlled study with a follow-up of 1 year.
UNLABELLED In arthroplasty the term " minimal invasive " not only refers to the length of the skin incision but more so to its soft tissue and thereby muscle-protecting features . STUDY AIM The aim of this study is to compare the early postoperative mobilisation and rehabilitation of the different surgical approaches in cementless total hip arthroplasty . METHODS 27 patients underwent a total hip replacement ( Trilogy cup , MAYO stem ) via a ventral minimal invasive approach ( one incision technique ) ( MIS group ) . 23 patients underwent a total hip replacement with the same implant via a anterolateral transgluteal approach ( st and ard group ) . We evaluated the Harris Hip Score ( HHS ) , the visual analogue scale ( VAS ) for pain and patient satisfaction preoperatively as well as 3 days , 10 days , 6 weeks and 3 months postoperatively . RESULTS After 3 and 10 days the MIS group showed better scores for pain , gait and mobilisation as well as for the overall HHS compared to the st and ard group . These differences could not be shown 6 weeks postoperatively . The MIS group had a significantly higher rate of complications with 22 % transient impairment of the lateral cutaneous nerve . CONCLUSION The patients of the MIS group showed a better mobilisation and rehabilitation during the early postoperative period . This can be attributed to the lessened intraoperative damage of to soft tissue and especially muscle damage . Due to the increased rate of nerve irritations , we modified our surgical approach . The minimal invasive approach to modern hip joint arthroplasty remains a non-st and ard technique . Compared to the st and ard approach it carries additional risks ( like nerve damage and malpositioning of the implants and thus should remain in the h and s of the experienced orthopaedic surgeon in specialised orthopaedic centres 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 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 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 st and ard approach . In the present study , a minimally invasive approach was compared with a traditional st and ard approach in terms of the effect on gait kinematics as demonstrated with gait analysis and electromyography . METHODS Twenty r and omized 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 st and ard transgluteal Hardinge approach ( st and ard group ) . All patients received the same cementless implant , inserted with use of st and ard 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 st and ard 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 st and ard 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 st and ard transgluteal approach Purported advantages of total hip arthroplasty performed with minimally invasive surgical ( MIS ) approaches are less muscle damage and faster recovery . There are little data scientifically evaluating these cl aims . Twenty-four consecutive hips were r and omized to total hip arthroplasty through 1 of 3 MIS approaches ( 2-incision , mini-posterior , and mini-anterolateral ) . Each patient underwent preoperative and postoperative gait analysis . Gait parameters included vertical ground reaction force , velocity , single-leg stance time , limb-loading rate , and abductor torque . All 3 groups demonstrated overall improvements in gait parameters at 6 weeks postoperatively . The anterolateral approach patients showed a decrease in the vertical ground reaction force at mid-stance , whereas the 2-incision and posterior approaches demonstrated no significant change . These results fail to demonstrate any significant advantage of the 2-incision approach over the posterior approach in kinetic gait parameters . Furthermore , the anterolateral approach demonstrates a gait pattern consistent with abductor muscle injury in the early recovery period , despite the MIS approach 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 Background The rehabilitation of patients for total hip arthroplasty is unsatisfactory , especially the prolonged rehabilitation . Aims To explore indications and key points of anterolateral minimally-invasive total hip arthroplasty . Methods 110 patients admitted for unilateral total hip arthroplasty were r and omly selected for surgery with either anterolateral minimally-invasive incision or st and ard posterolateral incision .  Demographic data , perioperative index and postoperative function index were recorded and statistically analyzed . Results No significant difference was detected in operation time , abduction angle , anteversion angle , stem alignment and stem fixation . The incision length , blood loss , perioperative transfusion and 100-mm VAS score at the first 24 h in minimally-invasive group were significantly lower . The Harris hip score and Barthel index were significantly higher in minimally-invasive group at 3 months ’ follow-up , but not significantly different 3 years after operation . Conclusions There are fewer traumas , fewer blood losses and more rapid recovery in this approach BACKGROUND Minimally invasive prosthetic hip surgery ( MIS ) attempts to minimise the extent of the operation . The aim of the study was to describe minimally invasive hip surgery and to present early clinical experience of the authors . MATERIAL AND METHODS 41 minimally invasive hip replacements through a posterior approach were carried out at the Orthopaedic Department of the Postgraduate Medical Education Centre in Otwock between 2004 and 2006 . 29 of those patients were included into the study , of whom 23 presented for follow-up . A control group consisted of 29 r and omly selected patients operated on using the classical method . Patients qualified for MIS had a BMI below 30 and a structurally normal hip joint with a good range of motion .  RESULTS Early results were subjected to a statistical analysis of 20 parameters . CONCLUSION 1 . The analysis showed that statistically significant baseline differences between MIS and traditionally treated patients included only BMI scores , structure of the hip joint and range of motion . 2 . Implantation of a hip endoprosthesis in a MIS procedure does not differ from the traditional operation utilising a posterior access except for skin incision length The advantages of minimally invasive surgical approaches for total hip arthroplasty are reported to include reduced blood loss , less pain , and shorter hospital stays , which combine to afford a faster recovery1 - 4 . However , other studies have failed to show any significant advantage over the use of st and ard surgical approaches ( Fig. 1)5 - 8 . Reported disadvantages of minimally invasive techniques are the substantial learning curve required and an increased risk of early complications3,9 - 12 . In addition , the long-term outcomes of minimally invasive procedures in terms of implant fixation and longevity remain unproven . Fig. 1 The st and ard direct lateral approach to the hip previously described by Frndak et al.21 is performed with the patient in the lateral decubitus position . ( Printed with permission of Joint Implant Surgeons , Inc. ) There are three basic categories of so-called minimally invasive total hip arthroplasty approaches : an abbreviated incision ( small incision ) , modifications of st and ard approaches with smaller incisions and less soft-tissue dissection ( less invasive ) , and novel approaches that reportedly do not cut muscle ( minimally invasive ) . We have had a broad experience , over the past seven years , with a less invasive modification of the direct lateral approach ( a modified Hardinge approach ) ( Fig. 2 ) . We previously reported less blood loss and a shorter hospital stay in association with this approach13 . Others have argued that the less invasive direct lateral approach does not provide an advantage over the traditional approach5 . Importantly , the soft-tissue dissection still requires removing and repairing the abductor musculature . Fig. 2 The less invasive direct lateral approach is performed with the patient in the lateral decubitus position . This approach employs an abbreviated skin and fascial incision with a limited abductor muscle dissection13 . ( Printed with permission of Joint Implant Surgeons , Inc. ) Several recent reports have Minimally invasive surgery has become a trend over the last few years in all aspects of orthopaedic surgery , including total hip arthroplasty . So-called mini-incision techniques involve limiting the length of the skin incision to 10 cm with use of either an anterior , lateral or posterior approach . Between March 2004 and December 2005 one hundred consecutive unilateral total hip replacements were performed by the same senior surgeon in our institute . All patients were r and omly assigned to study group ( group A ) or control group ( group B ) . In group A ( 50 patients ) the  skin incision was 8 cm ; in group B ( 50 patients ) the skin incision was st and ard ( about 12 - 14 cm ) . Patient demographic data , including sex , age , height , weight , BMI , diagnosis and preoperative Harris hip score were recorded . Other criteria evaluated included the perioperative and postoperative complications , the surgical time , the blood loss , the length of the incision , the acetabular and stem positions , the length of hospital stay , Harris Hip Score ( HHS ) and the WOMAC osteoarthritis index at six months . No significant differences were found between the groups with respect to the average surgical time , the acetabular and stem position , the length of hospital stay and the Harris Hip Score ( HHS ) and the WOMAC osteoarthritis index at six months . A significant lower blood loss was found in the mini-incision group . A higher percentage of peri-operative complications was recorded in Group A ( two stupor of sciatic nerve and one fracture of the greater trochanter ) . On the basis of our experience we could speculate that minimally invasive surgery should be directed to the new surgical approach with muscle sparing , instead of a shorter skin incision using st and ard approaches Minimally invasive total hip arthroplasty  using a short skin incision is a subject of much debate in the literature . The present study estimates the possible minimal length of the exposure in an unselected patient cohort and compares the lateral mini-incision technique and traditional total hip arthroplasty ( THA ) .  One hundred and two patients were divided into three groups according to the type of surgery and length of incision : mini-incision ( less than 10  cm ) was performed in 38 patients ; midi-incision ( 10–14 cm ) in 43 ; and  st and ard-incision ( longer than 14 cm ) in 21 patients . No statistical difference was found with regard to intraoperative and total blood loss , the rate of complications , and postoperative recovery . Significantly decreased body mass index ( BMI ) , shorter operative time , and higher number of hips with malpositioning of the acetabular cup were found in the mini-incision group . These patients , however , experienced less pain in the early postoperative period and were highly satisfied with the cosmetic results . The length of incision was shortened and optimized ( less than 14 cm ) in 82 % of patients , and mini-incision was performed in 38 patients of this unselected cohort . Because of the underst and able dem and of the patients for less invasive intervention , the surgeon should use a smaller but not necessarily mini-incision with minimal soft tissue trauma that still allows him to perform the procedure well , without compromising the type of implants and the otherwise excellent long-term results . R and omized prospect i ve studies are needed to explore the real value of the minimally invasive total hip arthroplasty . RésuméLa chirurgie arthroplastie de la hanche par voie mini invasive est un sujet de débat et de controverse dans la littérature . Cette étude a pour but d’estimer la longueur minimale de la voie d’abord sur une suite de patients non sélectionnés et de comparer la technique de mini incision avec la technique d’incision traditionnelle antérolatérale .  Cent deux patients ont été divisés en trois groupes , en fonction du type de chirurgie et en fonction de la longueur d’incision . Premier groupe : mini incision moins de 10 cm chez 38 patients , deuxième groupe : incision moyenne 10 à 14 cm chez 43 patients et troisième groupe : incision st and ard , supérieure à 14 cm chez 21 patients . Aucune différence statistique n’a été trouvée pour la perte sanguine et sur le taux des complications post-opératoires . Dans le groupe des mini incisions peu de sujets avaient une surcharge pondérale , par contre , il existait un gr and nombre de hanches avec une mal position de la cupule . Ces patients ont cependant présenté moins de douleur dans la période post-opératoire et ont été très satisfaits du résultat cosmétique . La longueur de l’incision dans la chirurgie prothétique de la hanche peut être raccourcie et la longueur optimum peut être de moins de 14 cm chez 82 % des patients . Une mini incision a été réalisé dans cette série , chez 38 patients du fait de la dem and e des patients pour une chirurgie mini invasive , les chirurgiens ont utilisé une petite incision avec un minimum de traumatisme des tissus mous . Cette mini incision doit donc permettre au chirurgien de réaliser son intervention correctement sans compromission sur le type d ’ implants , ni sur la qualité des résultats à long terme . Il n’y a pas besoin pour cela nécessairement d’une mini incision néanmoins des études prospect ives r and omisées doivent être réalisées pour explorer le vrai résultat de la chirurgie arthroplastie par voie mini invasive 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 Introduction We conducted a prospect i ve study to compare the exposure and implant positioning in primary total hip replacement through the anterolateral minimally invasive ( ALMI ) approach versus the posterior minimally invasive ( PMI ) approach . Material s and methods We applied these techniques to 2 consecutive groups ( 33 and 43 patients , respectively ) comparable preoperatively . All the patients received the same cementless stem and acetabular component . Results There were neither significant difference in femoral or acetabular component positioning nor in limb-length discrepancy . Acetabular exposure was easy through the ALMI approach . Femoral exposure was more difficult as fractures of the trochanter and femoral perforation in our study show . Conclusion For us , exposure and implant positioning through the ALMI approach and the PMI approach are comparable and reliable . However , we recommend caution during the initial learning curve in osteoporotic patients due to the higher rate of peroperative complications for the ALMI approach OBJECTIVE Intertrochanteric hip fractures are very common and early mobilisation correlates with a better outcome . The ideal surgical procedure should protect the soft tissue envelope , thereby preserving blood supply and reducing blood loss . Furthermore , occupational exposure to fluoroscopy that is used in hip fracture fixation remains a concern amongst orthopaedic surgeons . Computer-aided surgery can help to reduce reliance on fluoroscopy . We therefore combined the principles of minimally invasive plate osteo synthesis ( MIPO ) and computer navigation to describe a new procedure . We also present our results using this technique of minimally invasive computer-navigated dynamic hip screw fixation ( navMIS-DHS ) , and compare it to computer-navigated open DHS fixation ( nav-DHS ) and to conventional open DHS fixation ( conv-DHS ) . MATERIAL S AND METHODS This paper has three parts . In the first part , we describe the procedure of navMIS-DHS in detail . In the second part , we present our initial retrospective pilot series of 35 cases . Amongst them we performed 5 navMIS-DHS , 3 nav-DHS and 27 conv-DHS .  There were also two cases of conv-DHS  deliberately performed with a mini-incision in an attempt to see if we could duplicate the 5 cm incision that we achieved with navMIS-DHS . All patients were followed up for a minimum of 6 months . In the third part , we performed a single surgeon prospect i ve evaluation of navMIS-DHS versus conv-DHS involving 43 fractures in two arms . RESULTS We were able to achieve reduction in fluoroscopy time . There was also reduction in opiate requirement post-operatively in the minimally invasive procedure . The incision sizes were also smaller . The prospect i ve study also showed less wound-related complications in navMIS-DHS and a shorter time to ambulation . Implant positions were acceptable but we have also described how it may be improved . CONCLUSIONS Navigated MIS-DHS , by virtue of less pain , better healing , earlier rehabilitation and potentially shorter hospital stay , would benefit both the patients and reduce the economic strain on the health care system . It is a safe and reproducible procedure . Technical difficulties are present and these need to be addressed with further modifications of technique , and instrumentation In this prospect i ve study we compared clinical and radiological results and rehabilitation progress of 64 patients who underwent total hip arthroplasty using the st and ard lateral approach with 64 patients operated with a minimal-invasive ( MIS ) posterior approach .  The outcome of our study did not show any significant differences with regard to patient 's safety such as complication rate and radiological assessment of the cup position . There was no difference in the duration of surgery , blood loss , hospital stay and postoperative leg length discrepancy . Rehabilitation milestones were achieved earlier by MIS patients and three and six months postoperatively , the Harris Hip Score of the MIS group was significantly higher 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 Anterolateral minimally invasive hip surgery ( ALMIS ) is a challenging procedure that is thought to offer a more expedient and a better functional outcome . Seventy-nine patients receiving primary hip arthroplasty were r and omized .  Röttinger ALMIS technique was used for 42 patients , whereas 41 received the st and ard lateral transgluteal Hardinge approach .  Operative time was longer with ALMIS ( P = .000078 ) , whereas blood loss was less ( P = .008 ) . Surgical and postoperative complication rates , morphine consumption , and length and cost of hospitalization were similar . At 1 year , Harris , Postel and Merle d'Aubigné , and Short Form-36v1 scores were similar . Gait analysis revealed similar results . Computed tomographic analysis revealed no significant difference in implant position , heterotopic ossification , and loosening .  Röttinger ALMIS is a valid approach for hip arthroplasty . However , it offers no advantages at 1 year
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 .