Minimally Invasive Total Hip Arthroplasty Using a Transpiriformis Approach: A Preliminary Report

Abstract

Background Continuing efforts have been made to develop minimally invasive surgery techniques for THA. One of the most commonly performed of these techniques is the mini-posterior approach. All reported series using this approach describe surgical detachment of the short external rotators of the hip. In 2008, Penenberg et al. described an innovative surgical technique that preserves the short external rotators. We present the results of a singleincision modification of this technique in 135 patients. Description of TechniqueThis technique is based on preservation of all of the short external rotators of the hip with the exception of the piriformis or conjoined tendon. This single-incision technique required the development of specialized instrumentation for exposure and reaming of the acetabulum. The specialized retractors also successfully minimized trauma to the skin and subcutaneous tissue. Methods For the 135 patients undergoing THA with this technique, we analyzed demographic and operative data. We recorded complications, evaluated postoperative clinical function using the Harris hip score, and assessed cup abduction angle, cup anteversion, and stem alignment on radiographs. Minimum followup was 14 months (mean, 22 months; range, 14-33 months). Results There were no dislocations, no sciatic nerve palsies, no wound complications, and low transfusion rates (8%). The postoperative Harris hip score averaged 96.5 (range, 87-100). Overall acetabular cup abduction angle averaged 41°(range, 21°-49°) and anteversion averaged 21°(range, 15°-27°). Four percent and 2% of femoral components were inserted into more than 2°varus and 2°v algus alignment, respectively.

Early clinical and radiological results of minimally invasive total hip replacement

“…Many reports have shown that scores after MI THR are as good as those obtained using standard approaches. 3,7,10 Similarly, we observed significant ameliorations in 3-month HHS scores after THR compared to preoperative scores.…”

“…3 Roger and Hill reported mean acetabular cup inclination and anteversion angles of 418 (AE21.498) and 218 (AE15.278), respectively, in 135 cases treated via the posterior MI technique. 7 In our study, the mean acetabular cup inclination was 45.118 (AE7.738) and the mean acetabular anteversion angle was 7.488 (AE9.588); 61 of our cases were within the Lewinnek safe zone. Only one of the remaining 12 cases (outside of the Lewinnek safe zone) had an instability that required revision.…”

“…Roger and Hill studied 135 MI posterior THR cases and found five instances of femoral stem varus positioning of more than 28, and three cases of such femoral stem valgus positioning. 7 Poehling-Monaghan et al compared 96 cases of MI posterior THR with standard anterolateral THR, and found femoral stem varus positioning in one patient and femoral stem valgus positioning in 15. In the same paper, they also reported that of the 126 instances of the standard anterolateral approach, 34 had femoral stem varus positioning and three had femoral stem valgus positioning.…”

Incidence and Location of Pain in Young, Active Patients Following Hip Arthroplasty

“…While the exact etiology of trochanteric pain following hip arthroplasty is often unclear, potential causes include greater trochanteric bursitis or tendinosis of the gluteus medius or minimus tendons [41][42][43]. Recently, several modifications of the posterior approach to the hip (sometimes referred to as "micro-posterior" approaches) have been introduced with the intent of avoiding disruption of the iliotibial band and short external rotators, thus potentially decreasing the incidence of postoperative pain [44,45]. However, the true impact of these modifications requires further investigation.…”

A systematic review and meta-analysis of SuperPATH approach in hip arthroplasty

“…As minimally invasive surgery technology develops, it had improved the surgical results and reduced the possibility of surgical injury. More and more minimally invasive approaches were being proposed and developed, and minimally invasive technique was the trend of future [1][2][3].…”