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.

A new short uncemented, proximally fixed anatomic femoral implant with a prominent lateral flare: design rationals and study design of an international clinical trial

“…To reduce the risk of a varus movement through a higher lever arm, long and extra long femoral heads should not be used with high offset implants. The implant lends itself to minimal invasive surgery done with a Smith-Petersen or MicroHip ® approach, where conventional straight stems with a lateral shoulder may increase the risk of damaging the great trochanter and/or the abductor tendons [ 36 , 37 ]. However, one major concern in short hip stems is primary and torsional stability.…”

Mid-Term Outcome of Total Hip Arthroplasty Using a Short Stem

“…24 A long stem with a lateral shoulder increases the risk of damage to greater trochanter and/or abductor tendons. 25,26 The round-the-corner technique for prosthesis implantation preserves the integrity of the trochanteric area with its muscular attachments; shortening of the distal stem maximises bone and soft tissue conservation and enables a minimally invasive approach. 27 Periprosthetic bone loss and bone remodelling following THA are determined by the bone quality, implant design and material, and fixation method.…”

Mid-term results of cemented hip arthroplasties through the direct anterior approach in the lateral decubitus position: a retrospective cohort study

“…The operation was carried out according to the technique described by Michel and Witschger [ 23 ]. They describe an anterior, minimally invasive, surgical approach to the hip joint in lateral decubitus position on a regular operation table without traction.…”

“…In the vast majority of studies describing the anterior approach, the patient is positioned supine with or without traction [1,[10][11][12][13][14][15][16][17][18][19][20][21][22]. This approach can also be carried out in the lateral decubitus position [23]. A theoretical advantage of this position is that it causes less effort to expose the femur during surgery while the leg is simply positioned in hyperextension, abduction and external rotation.…”