Article révisé par les pairs
Résumé : In addition to the choice of the surgical approach, the respective place of the mini-incisions and mini-invasive surgery for total hip arthroplasty (THA) remains a controversial topic. The purpose of this study was to specify the advantages and disadvantages of these different approaches by a systematic review of the orthopedic literature and by our experience of the first 100 THA implanted by mini-invasive direct anterior approach (DAA) on orthopedic table. Selecting 15 orthopedic journals, we found 252 articles among which 65 are particularly relevant; 25 correspond to randomized studies. Mini-invasive approaches permit to obtain results at least equivalent to standard approaches with regard to operative time, general complications and adequate component positioning. Contrarily to posterior approach, DAA is associated to a low dislocation rate, even in so-called "at risks patients". Recent randomized studies highlight an earlier functional recovery in patients treated by mini-invasive approaches and particularly by DAA. This advantage seems to persist only the first six weeks but it could be interesting to patients avid to resume quickly their activities. Nevertheless, further studies are mandatory to confirm the observed results and to specify the place of the mini-invasive approaches with regard to early recovery as long-term results.