Posterolateral Mini-Incision Total Hip Arthroplasty

A “mini-incision” approach for total hip arthroplasty has been developed. Between January 1, 1998, and August 1, 2002, 1,489 such procedures were performed. During recent years, incision size has progressively decreased to what is now typically 6.0 to 8.5 cm. Adequate exposure and proper component positioning has been consistently achieved. In this article, the results of a consecutive series of 100 patients will be reported. An oblique skin incision was made and a posterior approach was used. A modular, noncemented acetabular component was used; acetabular fixation screws were easily inserted with this approach. The technique is applicable to both cemented and noncemented femoral components. New retractors have been developed to protect the proximal angle of the incision and elevate the femur for canal preparation. A new, doglegged acetabular inserter has been developed to protect the distal pole of the incision and ensure appropriate cup abduction. A posterior capsular closure incorporating capsule and short external rotators is easily performed through this incision. The potential disadvantages of minimal incision total hip arthroplasty are many, including a tendency to vertical cup placement if proper care is not taken and a tendency to a posterior starting point for femoral component insertion. Care must be taken to avoid abrasion of the proximal and distal poles of the wound. The potential advantages of minimal incision total hip arthroplasty include decreased bleeding, decreased operative time with improved patient comfort and patient satisfaction. Rehabilitation has been hastened, and cosmesis has been improved. Minimal incision total hip arthroplasty has become a predictable one-night stay procedure with major anticipated savings for the health care system.