J Korean Hip Soc.  2011 Sep;23(3):184-191. 10.5371/jkhs.2011.23.3.184.

Minimally Invasive Surgical Technique for Total Hip Arthroplasty

• Yoon TR
• Park KS
• Moon JY

• KMID: 2014884
• DOI: http://doi.org/10.5371/jkhs.2011.23.3.184

Abstract

Minimally invasive surgery is commonly used in a range of orthopedic fields with many surgeons employing minimally invasive techniques for total hip arthroplasty. Some surgeons, however, have recently suggested that the term 'mini-incision' is more correct than 'minimally invasive'. Many studies have reported the increased malposition of implants and complications, such as dislocations and nerve injury, in minimally invasive surgery due to the compromised visualization of the surgical field. Patient selection with the proper indications is of utmost importance for the success of minimally invasive total hip arthroplasty. In addition, selection of the correct surgical technique is essential. Furthermore, the procedure should be performed by an experienced surgeon with the appropriate surgical instruments.

Keyword

Hip; Joint replacement; Minimally invasive; Operation technique; Complication

MeSH Terms

Arthroplasty
Dislocations
Hip
Orthopedics
Patient Selection
Surgical Instruments

Figure

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  Fig. 1 The incision line of one incision MIS-THA with anterior approach.

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  Fig. 2 Judet table for one incision MIS-THA with anterior approach. This table can make the hip hyper extension, external rotational and adduction for femur reaming.

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  Fig. 3 The incision line of one incision MIS-THA with anterolateral approach.

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  Fig. 4 The incision line of one incision MIS-THA with posterolateral approach.

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  Fig. 5 Suction device combined with light source.

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  Fig. 6 The skin incision line of modified two incision MIS-THA.

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  Fig. 7 Piriformis muscle is used as a landmark to approach the posterior joint capsule.

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  Fig. 8 Photo graph of skin after wound closure.

Reference

1. Siguier T, Siguier M, Brumpt B. Mini-incision anterior approach does not increase dislocation rate: a study of 1037 total hip replacements. Clin Orthop Relat Res. 2004. 426:164–173.

2. Berger RA. Mini-incision total hip replacement using an anterolateral approach: technique and results. Orthop Clin North Am. 2004. 35:143–151.

3. Cameron HU. Mini-incisions: visualization is key. Orthopedics. 2002. 25:473.

4. Mears DC. Development of a two-incision minimally invasive total hip replacement. J Bone Joint Surg Am. 2003. 85-A:2238–2240.

5. Berry DJ, Berger RA, Callaghan JJ, et al. Minimally invasive total hip arthroplasty Development, early results and a critical analysis. Presented at the Annual Meeting of the American Orthopaedic Association, Charleston, South Carolina, USA, June 14, 2003. J Bone Joint Surg Am. 2003. 85-A:2235–2246.

6. Goldstein WM, Branson JJ, Berland KA, Gordon AC. Minimal-incision total hip arthroplasty. J Bone Joint Surg Am. 2003. 85-A:Suppl 4. 33–38.

7. Wenz JF, Gurkan I, Jibodh SR. Mini-incision total hip arthroplasty: a comparative assessment of perioperative outcomes. Orthopedics. 2002. 25:1031–1043.

8. Woolson ST, Mow CS, Syquia JF, Lannin JV, Schurman DJ. Comparison of primary total hip replacements performed with a standard incision or a mini-incision. J Bone Joint Surg Am. 2004. 86-A:1353–1358.

9. Callaghan JJ. Skeptical perspectives on minimally invasive total joint arthroplasty. J Bone Joint Surg Am. 2006. 85:2242–2243.

10. Berger RA. The technique of minimally invasive total hip arthroplasty using the two-incision approach. Instr Course Lect. 2004. 53:149–155.

11. Berger RA. Total hip arthroplasty using the minimally invasive two-incision approach. Clin Orthop Relat Res. 2003. 417:232–241.

12. Waldman BJ. Advancements in minimally invasive total hip arthroplasty. Orthopedics. 2003. 26:8 Suppl. s833–s836.

13. Sculco TP, Jordan LC. The mini-incision approach to total hip arthroplasty. Inst Course Lect. 2004. 53:141–147.

14. Richard DJ. Dorr LD, editor. Anterolateral approach for mini-incision total hip replacement. 2005. Philadelphia: Saunders;201–210.

15. Light TR, Keggi KJ. Anterior approach to hip arthroplasty. Clin Orthop Relat Res. 1980. 152:255–260.

16. Andrew GY. Dorr LD, editor. The anterior mini-incision intermuscular approach: a single incision. 2005. Philadelphia: Saunders;179–200.

17. Kennon R, Keggi J, Zatorski LE, Keggi KJ. Anterior approach for total hip arthroplasty: beyond the minimally invasive technique. J Bone Joint Surg Am. 2004. 86-A:Suppl 2. 91–97.

18. Kennon RE, Keggi JM, Wetmore RS, Zatorski LE, Huo MH, Keggi KJ. Total hip arthroplasty through a minimally invasive anterior surgical approach. J Bone Joint Surg Am. 2003. 85-A:39–48.

19. Hozack W. Minimally invasive total hip arthroplasty: Abstract: A randomized, prospective study comparing two surgical techniques. 2005. In : Closed Meeting of the the Hip Society; Pittsburgh, PA: The Hip Society.

20. Barber TC, Roger DJ, Goodman SB, Schurman DJ. Early outcome of total hip arthroplasty using the direct lateral vs the posterior surgical approach. Orthopedics. 1996. 19:873–875.

21. Hardinge K. The direct lateral approach to the hip. J Bone Joint Surg Br. 1982. 64:17–19.

22. Hedlundh U, Hybbinette CH, Fredin H. Influence of surgical approach on dislocations after Charnley hip arthroplasty. J Arthroplasty. 1995. 10:609–614.

23. Mulliken BD, Rorabeck CH, Bourne RB, Nayak N. A modified direct lateral approach in total hip arthroplasty: a comprehensive review. J Arthroplasty. 1998. 13:737–747.

24. Bertin KC, Röttinger H. Anterolateral mini-incision hip replacement surgery: a modified Watson-Jones approach. Clin Orthop Relat Res. 2004. 429:248–255.

25. Higuchi F, Gotoh M, Yamaguchi N, et al. Minimally invasive uncemented total hip arthroplasty through an anterolateral apporach with a shorter skin incision. J Orthop Sci. 2003. 8:812–817.

26. Min BW, Jeon SH, Lee KJ. Minimally invasive primary total hip arthroplasty. J Korean Hip Soc. 2003. 15:65–70.

27. Sherry E, Egan M, Warnke PH, Henderson A, Eslick GD. Minimal invasive surgery for hip replacement: a new technique using the NILAV hip system. ANZ J Surg. 2003. 73:157–161.

28. Waldman BJ. Minimally invasive total hip replacement and perioperative management: early experience. J South Orthop Assoc. 2002. 11:213–217.

29. Yoon TR, Bae BH, Rowe SM, Chung JY, Lee KB. Primary total hip arthroplasty with mini-incision technique: preliminary report. J Korean Orthop Assoc. 2003. 38:342–348.

30. Kim YS, Kwon SY, Sun DH, Han SK, Maloney WJ. Modified posterior approach to total hip arthroplasty to enhance joint stability. Clin Orthop Relat Res. 2008. 466:294–299.

31. Berger RA, Duwelius PJ. The two-incision minimally invasive total hip arthroplasty: technique and results. Orthop Clin North Am. 2004. 35:163–172.

32. Duwelius PJ, Berger RA. Minimally invasive total hip arthroplasty: the two-incision approach. Curr Opin Orthop. 2005. 16:5–9.

33. Yoon TR, Bae BH, Choi MS. A modified two-incision minimally invasive total hip arthroplasty: technique and short-term results. Hip Int. 2006. 16:Suppl 4. 28–34.

34. Yoon TR, Park KS. Minimally invasive total hip arthroplasty. J Korean Hip Soc. 2008. 20:80–90.

35. Yoon TR, Park KS, Song EK, Seon JK, Seo HY. New two-incision minimally invasive total hip arthroplasty: comparison with the one-incision method. J Orthop Sci. 2009. 14:155–160.

36. Yoon TR, Abbas AA, Lee KB, Kim KH. Modified two-incision minimally invasive total hip replacement for ankylosed hips. J Orthop Sci. 2009. 14:107–113.

37. Diwanji SR, Park KS, Yoon TR, Seo HY, Wie JS. Bilateral simultaneous two-incision minimally invasive total hip arthroplasty. J Orthop Sci. 2009. 14:517–524.

38. DiGioia AM 3rd, Blendea S, Jaramaz B, Levison TJ. Less invasive total hip arhtroplasty using navigational tools. Instr Course Lect. 2004. 53:157–164.

39. Pagnano MW, Trousdale RT, Meneghini RM, Hanssen AD. Patients preferred a mini-posterior THA to a contralateral two-incision THA. Clin Orthop Relat Res. 2006. 453:156–159.