MIS Approach for Hip Resurfacing
The minimally invasive surgical (MIS) technique represents one of the most exciting trends in hip arthroplasty. However, the question remains, is it more conservative and clinically favorable to have a minimally invasive soft tissue procedure, or is it better to conserve the bone stock and femoral architecture? This question was important, because these two philosophies, until recently, have been impossible to combine, since a minimally invasive soft tissue approach provides limited exposure, whereas a bony conservative philosophy requires a larger incision with significant soft tissue disruption. These limits became dramatically evident as resurfacing hip arthroplasty and minimally invasive soft tissue procedures became popular. Because of its focus on bone preservation, resurfacing hip arthroplasty requires a wide soft tissue exposure, that is, the ability to permit epiphyseal preparation and acetabular visualization. Additionally, even if the skin incision is reduced, the most common approach for resurfacing hip arthroplasty (posterolateral or posterior) requires detachment of short external rotators from the greater trochanter and a partial release of the gluteus maximus insertion, which obviously is contrary to truly minimally invasive soft tissue exposures (mini-Watson-Jones,1 mini-anterior,2 minimally invasive two-incision approach3). Furthermore, limited visualization in a mini-incision may pose increased risks of vascular complications (surgical damage of the femoral head blood supply is not uncommon with posterior exposure). As a result, different strategies have been developed; reduction of skin incisions with more limited muscular dissection (adapting instrumentation and developing specific surgical techniques) and development of techniques to accomplish resurfacing hip arthroplasty through intermuscular surgical approaches.
KeywordsGluteus Medius Minimally Invasive Surgical Trochanteric Osteotomy Medial Femoral Circumflex Artery Short External Rotator
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