MicroHip: a minimally invasive procedure for total hip replacement surgery. A modified Smith-Peterson 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 not a 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 6-8 cm, using this MI approach. The approach follows the interval between the tensor fascia lata muscle and the sartorius muscle using a section of the anterior iliofemoral approach described by Smith-Peterson. No tendon or muscle is cut or detached. The joint capsule is split and preserved in toto. 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 developed 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.

Influence of minimally invasive total hip replacement on hip reaction forces and their orientations

“…The force orientation suggests that rim‐loading did not occur in either model. Closest to the reference model would be the MicroHip® approach, which is described with a minimum of muscle trauma …”

“…This was done in a “worst‐case” scenario and to provide baseline data for modeling the influence of muscle trauma after THR. Closest to the reference model would be the anterolateral MIS approach (MicroHip® ‐ MH), where only a minimum of muscles/tendons are detached or incised . A femur is displayed in Figure with the respective muscle insertion and origin points.…”

Der minimalinvasive, anterolaterale Zugang zum Hüftgelenk zur Implantation von Endoprothesen in Rückenlage

“…ion elicited by elevation of the contralateral leg [4]. The minimally invasive modification of the more anterior Smith-Peterson approach [7] in the interval between the tensor fasciae latae and sartorius muscles is also conducted with the patient in the lateral decubitus [5]. This approach is also appropriate to the supine position [6], however, this variation places the lateral femoral cutaneous nerve at risk [9].…”

Accuracy of acetabular cup placement in computer-assisted, minimally-invasive THR in a lateral decubitus position

“…Both had familiarised themselves with minimally-invasive computer-assisted surgery by means of more than 50 navigated total hip arthroplasties. All operations were done with the patient in the lateral position through a minimally invasive, modified Smith-Petersen approach (MicroHip®) [8]. The anterior pelvic plane was registered in lateral decubitus position without surgical draping.…”