Minimally Invasive Approaches for Total Hip Arthroplasty: Systematic Review

Background. Currently, one of the most important goals in total hip arthroplasty is quick recovery of the patient's joint function and its early return to normal lifestyle. A special role in this goal realization is played by the surgical approach choice. The purpose of the study was to conduct a comparative assessment of minimally invasive approaches for total hip arthroplasty. Materials and methods. Electronic databases PubMed, Scopus, Cochrane Systematic Reviews, Google Scholar and eLIBRARY were searched for the period from 2000 to 2020. There were analyzed scientific publications, which highlighted the results of studies on the use of such minimally invasive approaches as direct anterior approach, MicroHip, Rottinger, mini-posterior, direct superior approach, SuperCap, PATH, and SuperPATH. Results. The total number of found publications was 3.210. The following publications were excluded: those that did not correspond to the search topic (n = 2197), those that were repeated (n = 190), those that had a summary (n = 576), those that reported the clinical case and did not have the results of the study (n = 192). 55 articles were selected, and the results of 10.798 surgeries were analyzed in total. The original data was combined and statistically processed using parametric analysis. Conclusion. The results analysis of the minimally invasive approaches use could not reveal evidence of any technique superiority. The indicators of blood loss, the length of the patient's stay in the hospital, and functional outcomes according to the Harris Hip Score after 3 and 12 months did not differ statistically between the groups. Statistically significant differences were found in the surgery duration between the direct superior approach and the SuperPATH approaches and in the values of the acetabular component inclination between some groups. The values of the inclination angle using the Rottinger and direct superior approaches, as well as the value of the acetabular component anteversion angle for direct anterior approach, Micro-Hip and SuperPATH approaches, slightly exceeded the parameters of the Lewinnek "safe zone". The acetabulum fracture as an intraoperative complication was recorded using all approaches. The most frequently observed postoperative complications were: periprosthetic fracture (5.83%), endoprosthesis head dislocation (5.4%), components loosening (4.5%), the lateral femoral cutaneous nerve injury (4.3%).