Minimal access surgery for total hip arthroplasty - current beliefs and activity profile in the UK

Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review

PURPOSE

Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data.

METHODS

Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs.

RESULTS

One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies.

CONCLUSIONS

This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.

Analysis of published evidence on minimally invasive total hip arthroplasty

Minimally invasive surgery has become a popular method of total hip arthroplasty. This study reviewed the literature to determine the number and quality of scientific publications analyzing different types of minimally invasive surgery approaches. The miniposterior approach has been studied the most and to our knowledge is the only approach with good quality randomized control study evidence. The overall length of follow-up and quality of reports for minimally invasive total hip arthroplasty is low.

Outcomes-based evaluations supporting computer-assisted surgery and minimally invasive surgery for total hip arthroplasty

Minimally invasive surgeries, as well as computer-assisted surgery for total hip replacement have gained popularity over recent years. This article provides an overview of state-of-the-art minimally invasive surgery (MIS) and computer-assisted surgery for total hip arthroplasty. A comprehensive review of the literature for scientific evidence supporting the use of these technologies was undertaken. This review evaluates whether commonly asked questions concerning these topics have been addressed. Controversy remains as to whether there are significant benefits of MIS or computer-assisted surgery for total hip arthroplasty. Fortunately, most studies report similar outcomes for both technologies. Minimally invasive techniques have been developed that do not significantly increase operative time or immediate postoperative complications. Computer-assisted navigation has shown improved radiographic alignment for total hip arthroplasty and may allow MIS to be performed more optimally. The authors believe that both of these technologies are likely to have a place in the future for hip arthroplasty with expectations of increased successful outcomes with these techniques while lowering complications and costs. Long-term outcomes of both techniques will need to be investigated.