Skip to main content
Log in

A Prospective Randomized Trial of Mini-incision Posterior and Two-incision Total Hip Arthroplasty

Clinical Orthopaedics and Related Research®

Cite this article



The two-incision approach to THA has been controversial, with some authors reporting its use is associated with a rapid recovery whereas others report no differences in outcomes and a higher risk of perioperative complications secondary to increased surgical complexity.


We therefore compared early postoperative variables including pain, length of stay, functional recovery, complications, and complexity of the mini-posterior and two-incision approaches to THA.

Patients and Methods

We prospectively enrolled 72 patients scheduled for THA and randomized them into two groups: mini-incision posterior approach and the two-incision approach. Preoperative teaching, anesthetic protocols, implants used, and rehabilitation pathways were identical for both groups. All variables were assessed at a maximum of 1 year postoperatively.


All key outcomes were similar in the two groups: mean visual analog scale (VAS) scores for pain during the first 3 postoperative days and the first 6 weeks, total narcotic requirements in the hospital and during the first 6 weeks, mean length of stay (51 hours versus 48 hours), and mean Harris hip scores and SF-12 scores. Achievement of functional milestones was similar between the two groups. There was one reoperation in each group. Mean operative time was longer for patients in the two-incision group (98 minutes versus 77 minutes), however the accuracy of component positioning was similar.


We found no differences in perioperative outcomes between these two approaches for THA. Variables other than the surgical approach including perioperative protocols, patient expectations, and the patient’s general health may have a greater effect on outcomes such as pain during the early postoperative period, functional recovery, and length of hospital stay. The use of small incisions for THA was safe as was a shortened hospital stay in selected patients.

Level of Evidence

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others


  1. Bal BS, Haltom D, Aleto T, Barrett M. Early complications of primary total hip replacement performed with a two-incision minimally invasive technique: surgical technique. J Bone Joint Surg Am. 2006;88(suppl 1 pt 2):221–233.

    Article  PubMed  Google Scholar 

  2. Berger RA. Total hip arthroplasty using the minimally invasive two-incision approach. Clin Orthop Relat Res. 2003;417:232–241.

    PubMed  Google Scholar 

  3. Berger RA. The technique of minimally invasive total hip arthroplasty using the two-incision approach. Instr Course Lect. 2004;53:149–155.

    PubMed  Google Scholar 

  4. Berger RA. A comprehensive approach to outpatient total hip arthroplasty. Am J Orthop (Belle Mead NJ). 2007;36(9 suppl):4–5.

    Google Scholar 

  5. Berger RA, Duwelius PJ. The two-incision minimally invasive total hip arthroplasty: technique and results. Orthop Clin North Am. 2004;35:163–172.

    Article  PubMed  Google Scholar 

  6. Berger RA, Jacobs JJ, Meneghini RM, Della Valle C, Paprosky W, Rosenberg AG. Rapid rehabilitation and recovery with minimally invasive total hip arthroplasty. Clin Orthop Relat Res. 2004;429:239–247.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. Duwelius PJ, Burkhart RL, Hayhurst JO, Moller H, Butler JB. Comparison of the 2-incision and mini-incision posterior total hip arthroplasty technique: a retrospective match-pair controlled study. J Arthroplasty. 2007;22:48–56.

    Article  PubMed  Google Scholar 

  9. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755.

    CAS  PubMed  Google Scholar 

  10. Howell JR, Masri BA, Duncan CP. Minimally invasive versus standard incision anterolateral hip replacement: a comparative study. Orthop Clin North Am. 2004;35:153–162.

    Article  PubMed  Google Scholar 

  11. Landefeld CS, Cook EF, Flatley M, Weisberg M, Goldman L. Identification and preliminary validation of predictors of major bleeding in hospitalized patients starting anticoagulant therapy. Am J Med. 1987;82:703–713.

    Article  CAS  PubMed  Google Scholar 

  12. Lombardi AV Jr, Berend KR, Mallory TH, Dodds KL, Adams JB. Soft tissue and intra-articular injection of bupivacaine, epinephrine, and morphine has a beneficial effect after total knee arthroplasty. Clin Orthop Relat Res. 2004;428:125–130.

    Article  PubMed  Google Scholar 

  13. Martell JM, Pierson RH III, Jacobs JJ, Rosenberg AG, Maley M, Galante JO. Primary total hip reconstruction with a titanium fiber-coated prosthesis inserted without cement. J Bone Joint Surg Am. 1993;75:554–571.

    CAS  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. Ostendorf M, van Stel HF, Buskens E, Schrijvers AJ, Marting LN, Verbout AJ, Dhert WJ. Patient-reported outcome in total hip replacement: a comparison of five instruments of health status. J Bone Joint Surg Br. 2004;86:801–808.

    Article  CAS  PubMed  Google Scholar 

  17. Pagnano MW, Leone J, Lewallen DG, Hanssen AD. Two-incision THA had modest outcomes and some substantial complications. Clin Orthop Relat Res. 2005;441:86–90.

    Article  PubMed  Google Scholar 

  18. 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.

    Article  PubMed  Google Scholar 

  19. Palutsis RS, Sheridan KC, Wasielewski RC. One surgeon’s experience with the 2-incision technique for total hip arthroplasty. J Arthroplasty. 2010;25:71–75.

    Article  PubMed  Google Scholar 

  20. Parvizi J, Mui A, Purtill JJ, Sharkey PF, Hozack WJ, Rothman RH. Total joint arthroplasty: when do fatal or near-fatal complications occur? J Bone Joint Surg Am. 2007;89:27–32.

    Article  PubMed  Google Scholar 

  21. 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.

    Article  PubMed  Google Scholar 

  22. Sriwatanakul K, Kelvie W, Lasagna L, Carimlin JF, Weis OF, Mehta G. Studies with different types of visual analog scales for measurement of pain. Clin Pharmacol Ther. 1983;34:234–239.

    Article  CAS  PubMed  Google Scholar 

  23. Wenz JF, Gurkan I, Jibodh SR. Mini-incision total hip arthroplasty: a comparative assessment of perioperative outcomes. Orthopedics. 2002;25:1031–1043.

    PubMed  Google Scholar 

  24. 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.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Craig J. Della Valle MD.

Additional information

This study was supported by a grant from Zimmer Inc (Warsaw, IN). Dr. Della Valle has performed consulting services for Zimmer within the past year and presently is a consultant for Smith and Nephew Inc (Memphis, TN), Biomet Inc (Warsaw, IN), and Kinamed Inc (Camarillo, CA). Dr. Sporer is a consultant for Zimmer.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

About this article

Cite this article

Della Valle, C.J., Dittle, E., Moric, M. et al. A Prospective Randomized Trial of Mini-incision Posterior and Two-incision Total Hip Arthroplasty. Clin Orthop Relat Res 468, 3348–3354 (2010).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: