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Clinical Orthopaedics and Related Research®

, Volume 470, Issue 8, pp 2227–2234 | Cite as

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

  • Douglas J. RogerEmail author
  • David Hill
Multimedia Article

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 single-incision modification of this technique in 135 patients.

Description of Technique

This 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° valgus alignment, respectively.

Conclusions

This technique shows promise as an alternative tissue-sparing method for minimally invasive THA.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Keywords

Ketorolac Gluteus Maximus Sciatic Nerve Palsy Short External Rotator Preoperative Templating 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We thank Pete Bandel and R. Oliver Barrett for technical assistance and Nicole L. Ebarb for assistance with preparation of the manuscript.

Supplementary material

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References

  1. 1.
    Bal BS, Haltom D, Aleto T, Barrett M. Early complications of primary total hip replacement performed with a two-incision minimally invasive technique. J Bone Joint Surg Am. 2005;87:2432–2438.PubMedCrossRefGoogle Scholar
  2. 2.
    Berger RA, Duwelius PJ. The two-incision minimally invasive total hip arthroplasty: technique and results. Orthop Clin North Am. 2004;35:163–172.PubMedCrossRefGoogle Scholar
  3. 3.
    Berry DJ, Berger RA, Callaghan JJ, Dorr LD, Duwelius PJ, Hartzband MA, Lieberman JR, Mears DC. Minimally invasive total hip arthroplasty: development, early results, and a critical analysis. J Bone Joint Surg Am. 2003;85:2235–2246.PubMedGoogle Scholar
  4. 4.
    Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB. An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am. 1999;81:2–10.PubMedGoogle Scholar
  5. 5.
    Callanan MC, Jarrett B, Bragdon CR, Zurakowski D, Rubash HE, Freiberg AA, Malchau H. The John Charnley Award. Risk factors for cup malpositioning: quality improvement through a joint registry at a tertiary hospital. Clin Orthop Relat Res. 2011;469:319–329.PubMedCrossRefGoogle Scholar
  6. 6.
    Dorr LD, Maheshwari AV, Long WT, Wan Z, Sirianni LE. Early pain relief and function after posterior minimally invasive and conventional total hip arthroplasty: a prospective, randomized, blinded study. J Bone Joint Surg Am. 2007;89:1153–1160.PubMedCrossRefGoogle Scholar
  7. 7.
    Duwelius PJ, Hartzband MA, Burkhart R, Carnahan C, Blair S, Wu Y, Grunkemeier GL. Clinical results of a modular neck hip system: hitting the “bull’s-eye” more accurately. Am J Orthop (Belle Mead NJ). 2010;39:2–6.CrossRefGoogle Scholar
  8. 8.
    Fehring TK, Mason JB. Catastrophic complications of minimally invasive hip surgery: a series of three cases. J Bone Joint Surg Am. 2005;87:711–714.PubMedCrossRefGoogle Scholar
  9. 9.
    Goldstein WM, Branson JJ, Berland KA, Gordon AC. Minimal-incision total hip arthroplasty. J Bone Joint Surg Am. 2003;85(suppl 4):33–38.PubMedGoogle Scholar
  10. 10.
    Hartzband MA. Posterolateral minimal incision for total hip replacement: technique and early results. Orthop Clin North Am. 2004;35:119–129.PubMedCrossRefGoogle Scholar
  11. 11.
    Hedley AK, Hendren DH, Mead LP. A posterior approach to the hip joint with complete posterior capsular and muscular repair. J Arthroplasty. 1990;(5 suppl):S57–S66.Google Scholar
  12. 12.
    Howell JR, Garbuz DS, Duncan CP. Minimally invasive hip replacement: rationale, applied anatomy, and instrumentation. Orthop Clin North Am. 2004;35:107–118.PubMedCrossRefGoogle Scholar
  13. 13.
    Hungerford DS. Minimally invasive total hip arthroplasty: in opposition. J Arthroplasty. 2004;19(4 suppl 1):81–82.Google Scholar
  14. 14.
    Kao JT, Woolson ST. Piriformis tendon repair after total hip replacement. Orthop Rev. 1992;21:171–174.PubMedGoogle Scholar
  15. 15.
    Khan RJ, Fick D, Khoo P, Yao F, Nivbrant B, Wood D. Less invasive total hip arthroplasty: description of a new technique. J Arthroplasty. 2006;21:1038–1046.PubMedCrossRefGoogle Scholar
  16. 16.
    Kim YH. Comparison of primary total hip arthroplasties performed with a minimally invasive technique or a standard technique: a prospective and randomized study. J Arthroplasty. 2006;21:1092–1098.PubMedCrossRefGoogle Scholar
  17. 17.
    Kim YS, Kwon SY, Sun DH, Han SK, Maloney WJ. Modified posterior approach to total hip arthroplasty to enhance joint stability. Clin Orthop Relat Res. 2008;466:294–299.PubMedCrossRefGoogle Scholar
  18. 18.
    Meneghini RM, Smits SA, Swinford RR, Bahamonde RE. A randomized, prospective study of 3 minimally invasive surgical approaches in total hip arthroplasty: comprehensive gait analysis. J Arthroplasty. 2008;23(6 suppl 1):68–73.Google Scholar
  19. 19.
    Ogonda L, Wilson R, Archbold P, Lawlor M, Humphreys P, O’Brien S, Beverland D. A minimal-incision technique in total hip arthroplasty does not improve early postoperative outcomes: a prospective, randomized, controlled trial. J Bone Joint Surg Am. 2005;87:701–710.PubMedCrossRefGoogle Scholar
  20. 20.
    Pagnano MW, Trousdale RT, Meneghini RM, Hanssen AD. Patients preferred a mini-posterior THA to a contralateral two-incision THA. Clin Orthop Relat Res. 2006;453:156–159.PubMedCrossRefGoogle Scholar
  21. 21.
    Pagnano MW, Trousdale RT, Meneghini RM, Hanssen AD. Slower recovery after two-incision than mini-posterior-incision total hip arthroplasty: a randomized clinical trial. J Bone Joint Surg Am. 2008;90:1000–1006.PubMedCrossRefGoogle Scholar
  22. 22.
    Pellicci PM, Bostrom M, Poss R. Posterior approach to total hip replacement using enhanced posterior soft tissue repair. Clin Orthop Relat Res. 1998;355:224–228.PubMedCrossRefGoogle Scholar
  23. 23.
    Penenberg BL, Bolling WS, Riley M. Percutaneously assisted total hip arthroplasty (PATH): a preliminary report. J Bone Joint Surg Am. 2008;90(suppl 4):209–220.PubMedCrossRefGoogle Scholar
  24. 24.
    Pour AE, Parvizi J, Sharkey PF, Hozack WJ, Rothman RH. Minimally invasive hip arthroplasty: what role does patient preconditioning play? J Bone Joint Surg Am. 2007;89:1920–1927.PubMedCrossRefGoogle Scholar
  25. 25.
    Salido JA, Marin LA, Gomez LA, Zorrilla P, Martinez C. Preoperative hemoglobin levels and the need for transfusion after prosthetic hip and knee surgery: analysis of predictive factors [erratum in J Bone Joint Surg Am. 2002;84:79]. J Bone Joint Surg Am. 2002;84:216–220.PubMedCrossRefGoogle Scholar
  26. 26.
    Sculco TP. Minimally invasive total hip arthroplasty: in the affirmative. J Arthroplasty. 2004;19(4 suppl 1):78–80.PubMedCrossRefGoogle Scholar
  27. 27.
    Solomon LB, Lee YC, Callary SA, Beck M, Howie DW. Anatomy of piriformis, obturator internus and obturator externus: implications for the posterior surgical approach to the hip. J Bone Joint Surg Br. 2010;92:1317–1324.PubMedCrossRefGoogle Scholar
  28. 28.
    Stähelin T, Drittenbass L, Hersche O, Miehlke W, Munzinger U. Failure of capsular enhanced short external rotator repair after total hip replacement. Clin Orthop Relat Res. 2004;420:199–204.PubMedCrossRefGoogle Scholar
  29. 29.
    Suh KT, Park BG, Choi YJ. A posterior approach to primary total hip arthroplasty with soft tissue repair. Clin Orthop Relat Res. 2004;418:162–167.PubMedCrossRefGoogle Scholar
  30. 30.
    Vail TP, Mariani EM, Bourne MH, Berger RA, Meneghini RM. Approaches in primary total hip arthroplasty. J Bone Joint Surg Am. 2009;91(suppl 5):10–12.PubMedCrossRefGoogle Scholar
  31. 31.
    Wenz JF, Gurkan I, Jibodh SR. Mini-incision total hip arthroplasty: a comparative assessment of perioperative outcomes. Orthopedics. 2002;25:1031–1043.PubMedGoogle Scholar
  32. 32.
    Woolson ST, Mow CS, Syquia JF, Lannin JV, Schurman DJ. Comparison of primary total hip replacements performed with a standard incision or a mini-incision. J Bone Joint Surg Am. 2004;86:1353–1358.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  1. 1.Institute of Clinical Orthopedics and NeurosciencesDesert Regional Medical CenterPalm SpringsUSA

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