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.

Hip replacement with use of small incisions has been practiced selectively by a few practitioners for many years, but only in the last several years has so-called minimally invasive hip replacement been widely introduced to the majority of orthopaedic surgeons. Minimally invasive hip replacement, in fact, is not a single type of surgery but rather is a family of operations designed to allow total hip replacement to be done through smaller incisions, potentially with less soft-tissue disruption. The three main methods involve a combination of a small incision and a posterior approach to the hip, a combination of a small incision and an anterior approach to the hip, or two small incisions performed with use of the Smith-Peterson interval for acetabular placement and the approach usually used for femoral intramedullary nailing for femoral component insertion. Minimally invasive total hip arthroplasty has created much controversy among orthopaedic surgeons and a great deal of publicity in the popular press. Advocates emphasize the potential for these methods to reduce soft-tissue trauma and thereby reduce operative blood loss, postoperative pain, and hospitalization time; speed the postoperative recovery; and improve the cosmetic appearance of the surgical scar. Advocates view minimally invasive total hip arthroplasty as a logical extension of less invasive methods that have revolutionized other fields, such as arthroscopy, laparoscopic cholecystectomy, and cardiac surgery, just to name a few. Those with reservations about minimally invasive total hip replacement point out that conventional hip replacement already provides excellent pain relief, functional improvement, and durability with a low complication rate. Skeptics are concerned that minimally invasive procedures introduce new potential problems related to reduced visualization at the time of the operation, such as implant malposition, neurovascular injury, poor implant fixation, or compromised long-term results. Advocates of minimally invasive methods believe that minimally invasive hip arthroplasty holds …