Minimally invasive total hip replacement (MI THR) procedures that involve single- and double- incision techniques.
Patients who are eligible for THR due to degenerative, rheumatoid, or other arthritic diseases of the hip.
Emerging minimally invasive surgical techniques for hip replacement require specialized equipment. There is uncertainty regarding the clinical and economic arguments about the adoption of these techniques.
Methods and Results
Fifty-five articles describing 42 studies [12 randomized controlled trials (RCTs), 22 non-randomized comparative studies, and eight case series (including registry data)] were identified through a systematic literature review. Thirty-two compared single mini-incision with standard incision, including nine RCTs. One RCT compared double incision to single mini-incision. A cost-utility analysis of single incision procedures from the perspective of the Canadian public health care system and a 40-year time horizon was conducted. A value of information analysis was also conducted.
Implications for Decision Making
- Differences between minimally invasive and standard techniques exist, but the clinical significance is unknown. MI THR techniques may have some peri-operative advantages (less blood loss and shorter operative time), although these may be of limited clinical significance. Of particular concern is the absence of evidence on the rates of revision after a primary procedure.
- Single-incision MI THR is unlikely to be cost-effective. Single-incision techniques are associated with higher costs (C$20,400 versus C$19,100) and quality-adjusted life-years (7.48 versus 7.47) compared to standard THR resulting in an incremental cost per QALY gained of $148,300. The probability that MI THR is more cost-effective than standard THR for a decision maker willing to pay $50,000 for a QALY is 47%. These results are most sensitive to the cost of initial hospitalization and patient utility values in the first year post-treatment.
- Collecting long-term comparative information may be of value. Compared to expanding funding for single-incision MI THR, it would be cost-effective to spend up to C$480M on gathering additional data through field evaluation, to remove uncertainty regarding the effect of MI THRs on revision rates.
This summary is based on a comprehensive health technology assessment available from CADTH’s web site (www.cadth.ca): Coyle D, Coyle K, Vale L, de Verteuil R, Imamura M, Glazener C, Zhu S. Minimally Invasive Arthroplasty in the Management of Hip Arthritic Disease: Systematic Review and Economic Evaluation.