Minimally Invasive Hip Arthroplasty

Background

Minimally invasive surgical (MIS) approaches to hip arthroplasty remain controversial and have gained the attention of patients and surgeons alike. Some investigators report that MIS techniques result in faster rehabilitation and rapid recovery after total hip arthroplasty (THA). However, an increased rate of complications has been reported with minimally invasive techniques, with some more specific to the direct anterior approach (DAA). Further, significant learning curves have been associated with the various MIS approaches, and most recently the DAA. It has also been recently reported that total hip replacements performed via MIS techniques may have a substantially higher early failure rate compared with those THA's performed through a standard surgical approach.

The exact meaning and definition of “minimally invasive” as it relates to surgical approaches in THA remains ill-defined. It has been reported that the skin incision size itself does not appear to affect the early functional outcomes of THA, both with the mini-posterior approach (MPA) and the mini-direct lateral approach. More recently, the term “minimally invasive” is being emphasized in favor of popularizing approaches that claim to avoid muscle damage by performing THA through an internervous plane, such as the DAA, which avoids directly transecting or cutting muscles. This concept was originally purported by supporters of the MIS two-incision approach. However, both the direct anterior and two-incision procedures in THA have been shown to damage muscle, despite claims of the contrary.

This chapter will discuss the available research and evidence surrounding the various MIS approaches for THA. It is beyond the scope of this chapter to discuss the details of the various surgical approaches or surgical techniques. Rather, our intent is to present the available evidence on the clinical results, patient rehabilitation and recovery outcomes, and potential complications of the MIS approaches. Comparative clinical studies, cadaveric studies, and gait analyses are presented to compare and contrast the relative merits and potential drawbacks of the MIS approaches for THA.