INFO - Minimally invasive surgery not yet validated

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Minimally invasive surgery not yet validated

Rheumawire

Sep 28, 2004

Nainggolan

Park Ridge, IL - Despite much fanfare, there is little scientific

evidence of the purported advantages of minimally invasive joint

replacement over conventional surgery, says the American Association of

Hip and Knee Surgeons (AAHKS).

As previously reported by rheumawire, there has been an increase in

minimally invasive replacement of hips and knees, with 1 US surgeon

going so far as to offer outpatient, or " drive-through, " joint

replacements. Proponents argue that surgery and recovery times are much

shorter, and the outcomes just as good as with conventional surgery.

But AAHKS president Dr Santore has this warning: " We have

concluded that minimally invasive surgery has not yet been validated

with large-scale studies. More research is needed to better understand

if this type of procedure will benefit most joint-replacement patients,

just a select group of patients, or relatively few patients. "

The AAHKS recently issued two advisory statementsone for physicians and

one for patientson the pros and cons of minimally invasive and

small-incision hip and knee replacements [1].

The AAHKS advisory for surgeons says there is no precise and universally

accepted definition for minimally invasive and small-incision

joint-replacement techniques. Generally, small-incision surgery entails

performing the conventional hip or knee replacement but through a

smaller skin incision than contemporary surgery (ie, that used by most

surgeons today). Minimally invasive surgery uses not only a smaller

incision but also new exposure techniques. Sometimes, the term " less

invasive surgery " is used to encompass both approaches, the association

notes.

Generally, the term " less invasive " is used when incisions are

approximately one half that of contemporary surgery. Proponents have

pointed out several advantages to less invasive surgery, the association

notes. For example, reduced postoperative pain, shorter length of

hospital stay and rehabilitation, decreased blood loss, less scarring,

and earlier return to work.

But there are also several disadvantages, many related to the difficulty

of performing surgery within a restricted visual field. Complications

may also be more likely during the so-called " learning curve " for

surgeons. " Various authors and presenters have pointed out there may be

an increased overall complication rate. . . . This may lead to fracture,

malposition, and neurovascular injury. Length of surgery may be

increased, and this may lead to a higher rate of thromboembolism or

infection. Cost may be increased with longer operating times [and] need

for specialized equipment, " the association states

Ongoing research is required into many aspects of this new technology,

it says, including:

Long-term durability of the joint reconstruction.

Long-term pain relief, motion, and function of the joint.

Implant positioning.

Infection rate.

Incidence of thromboembolism.

Incidence of neurovascular injury.

Joint stability and dislocation rate.

Reoperation rate.

In the meantime, the AAHKS has this advice for patients: " If your

surgeon offers minimally invasive or small-incision surgery, ask about

potential short- and long-term risks and benefits. Review his or her

specific results for contemporary and minimally invasive surgery in

relation to fracture, infection, blood clot, neurovascular injury, and

dislocation rates. Inquire about his or her qualifications, competence,

and proficiency with the technique. "

" Much of the interest in less invasive surgery is based on the promise

of the same or better long-term results, with shorter and less painful

recovery, " the AAHKS says, but " this set of outcomes has not been

validated and there is not a great deal of scientific proof to support

it at this time. "

The most positive results have been demonstrated by a small number of

high-volume total joint centers and surgeons in selected patient

populations, it adds. " We will have a better understanding of the value

of this type of surgery in the future, " it concludes.

Source

American Association of Hip and Knee Surgeons AAHKS

releases advisory statements for patients, physicians on minimally

invasive joint replacement surgery Aug 20, 2004; Available at:

http://www.aahks.org/index.asp/fuseaction/news.main

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org