Minimally invasive total hip arthroplasty: the Hospital for Special Surgery experience

The mini-incision technique is not a radically new technique. The surgeon familiar with the posterior approach will immediately appreciate the inherent similarities. The technique can be developed on a graduated basis by individual surgeons. The surgeon should begin by documenting the length of his or her current routine incision, and then the incision can be progressively reduced in length at a rate that is comfortable. At no time is it necessary to compromise the goals of the procedure because of inadequate visualization. The mini-incision is not for every patient. Obese individuals (BMI> 30), patients with very muscular thighs, stiff hips, or severe deformity may not be candidates for an 8-cm incision, but familiarity with this technique allows even these patients to be operated on through a smaller incision than the traditional 20-25 cm. The initial drive for shorter incisions was a result of patient concerns regarding the cosmesis of the scars and the desire for a more rapid recovery. Subsequent development of the technique and clinical analysis over the last 7 years has shown that THA can be performed safely and effectively through a mini-incision in most patients. So far the author shave found no increased risk for intraoperative or postoperative complications and no problems with component malposition. Longer follow-up is required to determine the long-term outcome; however, in the short term, patients have less blood loss, shorter operative times, and a reduced incidence of limp and cane use at 6 weeks.