A randomised clinical trial comparing minimally invasive surgery to conventional approach for endoprosthesis in elderly patients with hip fractures

Roy, L.; Laflamme, G.Y.; Carrier, M.; Kim, P.R.; Leduc, S.

doi:10.1016/j.injury.2009.10.002

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Volume 41, Issue 4 , Pages 365-369, April 2010

A randomised clinical trial comparing minimally invasive surgery to conventional approach for endoprosthesis in elderly patients with hip fractures

L. Roy
- University of Montreal, Orthopaedic Surgery Division, Hôpital du Sacré Cœur, 5400 Gouin Ouest, Room C-2080, Montréal, Québec, Canada H4J 1C5
- Tel.: +1 514 332 6025x223; fax: +1 514 338 3542.
G.Y. Laflamme
- University of Montreal, Orthopaedic Surgery Division, Hôpital du Sacré Cœur, 5400 Gouin Ouest, Room C-2080, Montréal, Québec, Canada H4J 1C5
- Tel.: +1 514 332 6025x223; fax: +1 514 338 3542.
- Corresponding author. Tel.: +1 514 332 6025x223; fax: +1 514 338 3542.
M. Carrier
- University of Montreal, Orthopaedic Surgery Division, Hôpital du Sacré Cœur, 5400 Gouin Ouest, Room C-2080, Montréal, Québec, Canada H4J 1C5
- Tel.: +1 514 332 6025x223; fax: +1 514 338 3542.
P.R. Kim
- Department of Surgery, University of Ottawa, Room W1650, Ottawa Hospital – General Campus, 501 Smyth Road, Ottawa, Ontario, Canada K1H 8L6
- Tel.: +1 613 737 8774; fax: +1 613 737 8837.
S. Leduc
- University of Montreal, Orthopaedic Surgery Division, Hôpital du Sacré Cœur, 5400 Gouin Ouest, Room C-2080, Montréal, Québec, Canada H4J 1C5
- Tel.: +1 514 332 6025x223; fax: +1 514 338 3542.

Accepted 2 October 2009.

Abstract

Background

In recent years, the concept of minimally invasive surgery has invaded the orthopaedic field and literature on the subject is spawning. Mini-incision surgery for total hip arthroplasty has been studied without a clear consensus on the efficacy, safety and advantage of that technique. To our knowledge, the efficacy and safety of mini-incisions in hip fracture surgery has not been studied in a randomised fashion.

Methods

This study is a prospective clinically randomised trial whose primary objective was to demonstrate the safety and efficacy of a single posterior mini-incision approach compared to a standard posterior approach for endoprosthesis in acute femoral neck fractures. The mini-incision was defined as less than 8cm. 25 patients in the mini-incision surgery (MIS) group and 31 patients in the standard incision group (STD) were available for analysis. The following validated disease-specific outcome instruments were used: the Lower Extremity Measurement (LEM) and the Time Up and Go (TUG). Secondary endpoints of pain, function, and quality of life were assessed by the components of the Harris Hip Score (HHS) and SF-36. Radiographic outcomes were also evaluated as well as the rates of all reported complications and adverse events during the 2 years follow-up.

Results

There was no significant difference for operative time, blood losses, 72h postoperative haemoglobin as well as the need for transfusion therapy between the two groups. Also, there was no difference between the groups for postoperative morphine use and pain evaluation with the Visual Analog Scale. The functional assessment using LEM and TUG did not demonstrate any statistically significant difference between mini- and standard incision. However, the HHS and the physical function component of the SF-36 were statistically better at 2 years in favour of the standard incision group.

Conclusion

Based on the results of the present study, we cannot recommend the use of a minimally invasive approach over a standard approach in the implantation of a cemented endoprosthesis.

Keywords: Minimally invasive surgery, Endoprosthesis, Elderly, Hip fractures