Less Invasive Total Hip Arthroplasty
Description of a New Technique
Riaz J.K. Khan, FRCS (Tr and Orth), Daniel Fick, MBBS, Paul Khoo, MBBS,
Felix Yao, MBBS, Bo Nivbrant, PhD, and David Wood, MD
Abstract: We describe a new technique and aim to justify its use in total hip
arthroplasty. The incision is short and there is minimal soft tissue dissection:
piriformis and most of quadratus femoris remain intact. A meticulous capsular repair
is performed. Patients are mobilized without restrictions. One hundred total hip
arthroplasties by the standard posterior approach (group 1) were compared with
100 by the less invasive approach (group 2). Minimum follow-up was 2 years. Mean
blood loss in group 1 was higher ( P b .0001) and inpatient stay longer ( P b .0001).
There was greater improvement in WOMAC scores for up to 1 year in the less
invasive group ( P = .027). In conclusion, the less invasive approach is safe and the
functional benefits last up to 1 year. Key words: total hip arthroplasty, total hip
replacement, surgical approach, minimally invasive surgery.
n 2006 Elsevier Inc. All rights reserved.
Minimally invasive surgery for the hip has become
a topic of considerable debate and interest. Several
approaches have been described, including the
single-incision posterior approach [1-5], the sin-
gle-incision anterolateral approach [6], and the
dual-incision [7,8] and the single-incision anterior
approach [9,10]. The potential benefits include
lower surgical morbidity with less blood loss,
quicker rehabilitation, shorter inpatient stay, and
improved cosmesis [3,11]. On the other hand,
skeptics are concerned about increased complica-
tions as a result of reduced exposure, including
neurovascular injury, component malposition and
dislocation, leg length discrepancy, and loss of
implant fixation [12].
We describe a new single-incision less invasive
posterior approach to the hip. Our aim was to fully
assess the modified approach and justify its use in
total hip arthroplasty (THA).
Materials and Methods
The less invasive posterior approach was origi-
nally developed by one of the authors (DW)
between January and March 2002. Before that,
the standard posterior approach was routinely
used. A prospective cohort of THA patients by
the less invasive approach was compared retro-
spectively with a control group by the standard
posterior approach. Inclusion criteria to this study
were primary THAs with a principle diagnosis of
osteoarthritis or rheumatoid arthritis. Exclusion
criteria included revision arthroplasty, congenital
hip anomaly, previous hip surgery or infection,
and iatrogenic damage to the piriformis; no
patients were excluded because of age or body
mass. One hundred consecutive THAs suitable for
inclusion from April 2002 were recruited into the
study. Forty-four patients were excluded: revision
The Journal of Arthroplasty Vol. 21 No. 7 2006
1038
From the Department of Surgery and Pathology, University of
Western Australia, Perth, Western Australia.
Submitted August 9, 2005; accepted January 13, 2006.
No benefits or funds were received in support of the study.
Reprint requests: Riaz J.K. Khan, FRCS (Tr and Orth),
1/14 -16 Hamersley St, Cottesloe, WA 6011, Australia.
n 2006 Elsevier Inc. All rights reserved.
0883-5403/06/1906-0004$32.00/0
doi:10.1016/j.arth.2006.01.010