Muscle damage during minimally invasive total hip arthroplasty: cadaver-based evidence that it is significant

Minimally invasive total hip arthroplasty has generated substantial interest in both patients and surgeons. The concept that smaller incisions and less extensive surgical dissection should lead to less pain and a quicker recovery is inherently appealing. Advocates of minimally invasive total hip arthroplasty have suggested that some minimally invasive total hip approaches can be done without cutting any muscle or tendon. This contention has been carefully examined through a series of comparative cadaver studies, and the authors have determined that it is not possible to routinely perform minimally invasive total hip arthroplasty without causing some measurable degree of muscle damage. Anatomic studies showed that the two-incision approach with fluoroscopy, the posterior mini-incision approach, and the mini-incision Smith-Petersen approach all were associated with measurable muscle damage. The clinical importance of this muscle damage cannot be answered by these cadaver studies.