Six sigma analysis of minimally invasive acetabular arthroplasty: a preliminary investigation.
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SUBMITTER: Heck DA
PROVIDER: S-EPMC2706362 | biostudies-other | 2009 Aug
REPOSITORIES: biostudies-other
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Project description:BackgroundContinuing efforts have been made to develop minimally invasive surgery techniques for THA. One of the most commonly performed of these techniques is the mini-posterior approach. All reported series using this approach describe surgical detachment of the short external rotators of the hip. In 2008, Penenberg et al. described an innovative surgical technique that preserves the short external rotators. We present the results of a single-incision modification of this technique in 135 patients.Description of techniqueThis technique is based on preservation of all of the short external rotators of the hip with the exception of the piriformis or conjoined tendon. This single-incision technique required the development of specialized instrumentation for exposure and reaming of the acetabulum. The specialized retractors also successfully minimized trauma to the skin and subcutaneous tissue.MethodsFor the 135 patients undergoing THA with this technique, we analyzed demographic and operative data. We recorded complications, evaluated postoperative clinical function using the Harris hip score, and assessed cup abduction angle, cup anteversion, and stem alignment on radiographs. Minimum followup was 14 months (mean, 22 months; range, 14-33 months).ResultsThere were no dislocations, no sciatic nerve palsies, no wound complications, and low transfusion rates (8%). The postoperative Harris hip score averaged 96.5 (range, 87-100). Overall acetabular cup abduction angle averaged 41° (range, 21°-49°) and anteversion averaged 21° (range, 15°-27°). Four percent and 2% of femoral components were inserted into more than 2° varus and 2° valgus alignment, respectively.ConclusionsThis technique shows promise as an alternative tissue-sparing method for minimally invasive THA.Level of evidenceLevel IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
| S-EPMC3392401 | biostudies-literature
Project description:Isolated patellofemoral arthritis is a common debilitating condition in adults older than 40 years of age. Surgical options such as patellofemoral arthroplasty exist for those who failed to respond to nonoperative treatment. However, early patellofemoral arthroplasty techniques often resulted in poor outcomes due to mal-tracking and malalignment of components. Robotic-assisted surgery recently has been introduced as an alternative to classic patellofemoral arthroplasty, with the potential to improve the anatomical fit and reproducibility of implant positioning. We present the technique for minimally invasive robotic-assisted patellofemoral arthroplasty system.
| S-EPMC7188930 | biostudies-literature
Project description:Despite growing interest in minimally invasive surgery (MIS) techniques for total knee arthroplasty (TKA), few randomized controlled trials have compared MIS and conventional TKA using a combination of functional performance, knee pain, knee range of motion (ROM), and surgical and radiographic outcomes.A prospective, randomized investigation comparing early outcomes of TKA using conventional or MIS approaches (n = 44). Patients were assessed preoperatively, 48 hours, 4 and 12 weeks postoperatively by blinded evaluators. Outcome measures included timed-up-and-go, 100-ft walk, knee pain, passive knee ROM, Knee Society Score, blood loss, tourniquet time, hospital length of stay, surgical complications, and radiographic outcomes.No significant differences in functional performance, knee pain, knee ROM, surgical, or radiographic outcomes were observed between groups at 48 hours, 4 or 12 weeks postoperatively.While surgical and radiographic outcomes were not compromised with MIS surgery, there were also no improvements in pain, ROM, or functional performance with MIS TKA.
| S-EPMC4162390 | biostudies-literature
Project description:The development of new instrumentation and techniques has led to the rapid advancement of less invasive surgical approaches in total knee arthroplasty (TKA). Compared to the standard approach, minimally invasive surgery (MIS) in TKA was shown to reduce postoperative pain, blood loss, and hospitalization time, and to improve functional recovery. Growing experience with MIS-TKA has defined the proper indications for this technique. With a limited exposure, the skin, capsular tissues, and bone surfaces receive higher stresses because of the retraction required. Several complications relating to the MIS learning curve are now being reported. The reliability of a TKA procedure performed through a mini-incision, and its success, seems to depend on patient selection, surgeon experience, and surgical environment.
| S-EPMC2504119 | biostudies-other
Project description:ObjectiveTo explore the outcome and surgical technique of minimally invasive unicompartmental knee arthroplasty (UKA) for spontaneous osteonecrosis of the knee.MethodsTwenty-seven patients with medial compartmental spontaneous osteonecrosis treated by minimally invasive Oxford phase 3 UKA from January 2009 to June 2013 were reviewed retrospectively. Twelve subjects were men and 15 women, with an average age of 64.6 ± 8.6 years (52-82 years). At the time of diagnosis, 11 patients had with grade III necrosis and 16 grade IV according to Mont's classification. Pain, range of motion (ROM) and Hospital for Special Surgery (HSS) knee scores were evaluated before and after UKA. Pre-and postoperative alignment of the lower limbs was measured and compared. Postoperative radiographic assessments were made according to the guidelines proposed by the Oxford group at the final follow-up.ResultsAll patients were followed for a mean time of 27.8 ± 15.9 months (6-59 months). There were no serious adverse events, such as infection, bearing dislocation, aseptic loosening, pulmonary embolism, deep venous thrombosis, cardio-cerebral vascular incident or psychological problems. One revision was required for unrelated causes (fracture of tibia plateau) 3 years after arthroplasty. One femoral component was tilted with a postoperative radiographic angle >10°. One radiolucent line was observed in a patient with spontaneous osteonecrosis of the knee. The two patients with implant failure had no symptoms at last follow-up. Visual analogue scale scores decreased from 6.9 ± 0.9 to 2.0 ± 1.1 (t = 19.27, P = 0.00). Pain was relieved in 96.3% of subjects (26/27). The mean post-operative ROM and femorotibial angle were 125.7° ± 9.6° and 177.7° ± 3.1°, respectively. HSS scores increased from 61.3 ± 9.7 to 93.0 ± 4.8 (t = 14.46, P = 0.00). Of the 27 patients, 26 (96.3%) were satisfied with the outcome of this surgical procedure.ConclusionMinimally invasive UKA is an effective means of managing spontaneous osteonecrosis of the knee. The short-term outcome of UKA is encouraging.
| S-EPMC6583493 | biostudies-literature
Project description:BackgroundMinimally invasive total hip arthroplasty (MITHA) remains considerably controversial. Limited visibility and prosthesis malposition increase the risk of post-surgical complications compared to those of the traditional method.MethodsA meta-analysis was undertaken of all published databases up to May 2011. The studies were divided into four subgroups according to the surgical approach taken. The radiological outcomes and complications of minimally invasive surgery were compared to traditional total hip arthroplasty (TTHA) using risk ratio, mean difference, and standardized mean difference statistics.ResultsIn five studies involving the posterolateral approach, no significant differences were found between the MITHA groups and the TTHA groups in the acetabular cup abduction angle (p?=?0.41), acetabular anteversion (p?=?0.96), and femoral prosthesis position (p?=?0.83). However, the femoral offset was significantly increased (WMD?=?3.00; 95% CI, 0.40-5.60; p?=?0.02). Additionally, there were no significant differences among the complications in both the groups (dislocations, nerve injury, infection, deep vein thrombosis, proximal femoral fracture) and revision rate (p>0.05). In three studies involving the posterior approach, there were no significant differences in radiological outcomes or all other complications between MITHA or TTHA groups (p>0.05). Three studies involved anterolateral approach, while 2 studies used the lateral approach. However, the information from imaging and complications was not adequate for statistical analysis.ConclusionsPosterior MITHA seems to be a safe surgical procedure, without the increased risk of post-operative complication rates and component malposition rates. The posterolateral approach THA may lead to increased femoral offset. The current data are not enough to reach a positive conclusion that lateral and anterolateral approaches will result in increased risks of adverse effects and complications at the prosthesis site.
| S-EPMC3360020 | biostudies-literature
Project description: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 standard-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 understandable demand 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. Randomized prospective studies are needed to explore the real value of the minimally invasive total hip arthroplasty.
| S-EPMC2532092 | biostudies-other
Project description:Minimally invasive esophagectomy is increasingly performed for the treatment of esophageal cancer, but it is unclear whether hybrid minimally invasive esophagectomy (HMIE) or totally minimally invasive esophagectomy (TMIE) should be preferred. The objective of this study was to perform a meta-analysis of studies comparing HMIE with TMIE. A systematic literature search was performed in MEDLINE, Embase, and the Cochrane Library. Articles comparing HMIE and TMIE were included. The Newcastle-Ottawa scale was used for critical appraisal of methodological quality. The primary outcome was pneumonia. Sensitivity analysis was performed by analyzing outcome for open chest hybrid MIE versus total TMIE and open abdomen MIE versus TMIE separately. Therefore, subgroup analysis was performed for laparoscopy-assisted HMIE versus TMIE, thoracoscopy-assisted HMIE versus TMIE, Ivor Lewis HMIE versus Ivor Lewis TMIE, and McKeown HMIE versus McKeown TMIE. There were no randomized controlled trials. Twenty-nine studies with a total of 3732 patients were included. Studies had a low to moderate risk of bias. In the main analysis, the pooled incidence of pneumonia was 19.0% after HMIE and 9.8% after TMIE which was not significantly different between the groups (RR: 1.46, 95% CI: 0.97-2.20). TMIE was associated with a lower incidence of wound infections (RR: 1.81, 95% CI: 1.13-2.90) and less blood loss (SMD: 0.78, 95% CI: 0.34-1.22) but with longer operative time (SMD:-0.33, 95% CI: -0.59--0.08). In subgroup analysis, laparoscopy-assisted HMIE was associated with a higher lymph node count than TMIE, and Ivor Lewis HMIE was associated with a lower anastomotic leakage rate than Ivor Lewis TMIE. In general, TMIE was associated with moderately lower morbidity compared to HMIE, but randomized controlled evidence is lacking. The higher leakage rate and lower lymph node count that was found after TMIE in sensitivity analysis indicate that TMIE can also have disadvantages. The findings of this meta-analysis should be considered carefully by surgeons when moving from HMIE to TMIE.
| S-EPMC7455468 | biostudies-literature
Project description:ObjectiveMinimally invasive midvastus approach (mini-midvastus) has been widely used in total knee arthroplasty (TKA). However, the clinical effects still remains controversial. This meta-analysis was based on randomized controlled trials (RCTs) aiming to quantitatively analyze the clinical efficacy of mini-midvastus versus standard parapatellar approach in TKA.MethodsThis meta-analysis was performed according to the PRISMA guidelines. A literature search for the eligible RCTs was carried out in the databases of PubMed, the Cochrane library, EMBASE and Web of Science. Two independent reviewers independently completed the study selection, data extraction, and the assessment of methodological quality. Meta-analysis was conducted by the RevMan 5.2 software.ResultsA total of 18 RCTs (937 patients with 1093 TKAs) published from 2007 to 2013 were included. The meta-analysis suggested that the mini-midvastus approach significantly improved knee range of motion (ROM) and decreased visual analog score (VAS) at postoperative 1-2 weeks (p<0.05), and there were no statistical differences in terms of knee society score (KSS) (6 weeks to 1 year), VAS (6 weeks to 6 months), ROM (6 weeks to 6 months), lateral retinacular release, blood loss, straight leg raise, hospital stay and postoperative complications between the mini-midvastus and standard parapatellar approach (p>0.05). However, the operative time was significantly longer when performing the mini-midvastus group than the parapartellar approach (p<0.05).ConclusionThis meta-analysis found that compared with the standard parapatellar approach, the mini-midvastus approach had early advantages in the VAS and ROM, but had the disadvantage in the operative time.Level of evidenceTherapeutic study Level I.
| S-EPMC4028179 | biostudies-literature
Project description:Vascular injury during minimally invasive total hip arthroplasty (THA) is uncommon, yet a well-recognized and serious issue. It emerges because of non-visibility of vascular structures proximal to the pelvic bone during reaming, drilling holes, and fixing of screws. Numerous studies have found that screw fixation during cementless THA is beneficial for the initial stability of cup; yet, no anatomical guidelines support angular eccentric screw fixation.In this study, we obtained the pelvic arterial-phase computed tomographic data of thirty eight humans and reconstructed the three-dimensional models of osseous and vessel structures. We performed the surgical simulation to fix these structures with cementless cups and screws with angular eccentricities.The effect of screw eccentricities (angular eccentricities of ±17° and ±34°) on the vascular injury was determined. Measurement between screw and adjoining vessels was performed and analyzed statistically to ascertain a comparative risk study for blood vessels that are not visible during surgery.Authors similarly discussed the significant absence of appreciation of quadrant systems proposed by Wasielewski et al. on eccentric screws. Adjustment of quadrant systems provided by Wasielewski et al. is required for acetabular implants with eccentric holes for fixation of acetabular screws.
| S-EPMC5525526 | biostudies-other