Minimally invasive versus conventional exposure for total hip arthroplasty: a systematic review and meta-analysis of clinical and radiological outcomes

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. A systematic review of the published and unpublished literature was conducted to include all randomised and non-randomised controlled trials comparing the clinical and radiological outcomes of minimally invasive and conventional THA procedures. In total, 28 studies met the eligibility criteria and included 2,849 hips, i.e. 1,428 minimally invasive compared to 1,421 conventional THAs. 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.