MicroHip: A Minimally Invasive Procedure for Total Hip Replacement Surgery: A modified Smith-Petersen approach

Abstract

In this article we present the surgical technique of our anterior minimally invasive approach to the hip joint. This is aligned along an interneural plane and makes the approach truly minimally invasive. This technique is performed in a lateral decubitus position on a normal operating table; there is no need for a specific orthopaedic or fracture table. As leg traction is not necessary, this enables the approach to be used routinely. Most of the instruments used for this procedure are standard instruments; only the acetabular reamers and positioners are angulated and specifically designed. The angled instruments (MI minimally invasive) are especially useful when performing hip replacement in obese patients. An excellent view of both the acetabulum and the proximal femur can be obtained through an incision of only 6-8cm, using this MI approach. The approach follows the interval between the tensor fascia lata muscle and the rectus muscle using a section of the anterior iliofemoral approach described by Smith-Petersen. No tendon or muscle is cut or detached. The joint capsule is split and left in place. The hip joint is not dislocated and we perform the osteotomy of the femoral neck in situ. To date we have performed over 500 MicroHip operations. We have not observed any nerve lesions or fractures of the trochanter. Our experience to date shows that the method we have de-veloped allows us to operate reliably on virtually any patient. Preliminary results also show that important factors like length of stay, pain, blood loss and return to work can be reduced significantly. The MicroHip technique is being used by more and more different clinics all over the world and can be applied with success after suitable training.

Primary and long-term stability of a short-stem hip implant

“…This is ideal for bone remodelling. However, the down side is that this arthroplasty cannot be undertaken using minimally invasive techniques, a characteristic inherent to conservative short stems [44], such as the BMHR. Gibbons et al [45] compared the conservative CLS implant to a straight-stemmed, diaphyseally fixed implant over a 4 year period and found the former to cause less bone resorption in Gruen zones 1, 6, and 7.…”

A comparison of clinical, radiographic and surgical outcomes of total hip arthroplasty between direct anterior and posterior approaches: a systematic review and meta-analysis

“…3,4 At present, surgical approaches are moving towards the trend of “minimal invasion” and “rapid recovery”; thus, the direct anterior approach for THA has attracted widespread attention from orthopaedic surgeons. 5–11…”

Quantification of Femoral Neck Exposure Through a Minimally Invasive Smith-Petersen Approach

“…9,10 Alternatively, the direct anterior minimally invasive Smith-Petersen approach has also been described to reduce displaced femoral neck fractures. [11][12][13][14][15][16][17][18] It is a true internervous plane between the muscles innervated by the femoral nerve and the superior gluteal nerve. 19,20 The superficial interval is between the sartorius and tensor fascia latae, whereas the deep interval is between the rectus femoris and the gluteus medius.…”