Skip to main content
SpringerLink
Log in

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

  • Multimedia Article
  • Published:
Clinical Orthopaedics and Related Research®

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.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  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.

    Article  PubMed  Google Scholar 

  2. 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 

  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.

    PubMed  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  10. Hartzband MA. Posterolateral minimal incision for total hip replacement: technique and early results. Orthop Clin North Am. 2004;35:119–129.

    Article  PubMed  Google Scholar 

  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.

  12. Howell JR, Garbuz DS, Duncan CP. Minimally invasive hip replacement: rationale, applied anatomy, and instrumentation. Orthop Clin North Am. 2004;35:107–118.

    Article  PubMed  Google Scholar 

  13. Hungerford DS. Minimally invasive total hip arthroplasty: in opposition. J Arthroplasty. 2004;19(4 suppl 1):81–82.

    Google Scholar 

  14. Kao JT, Woolson ST. Piriformis tendon repair after total hip replacement. Orthop Rev. 1992;21:171–174.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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. 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 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  26. Sculco TP. Minimally invasive total hip arthroplasty: in the affirmative. J Arthroplasty. 2004;19(4 suppl 1):78–80.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  31. 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 

  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.

    PubMed  Google Scholar 

Download references

Acknowledgments

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

Author information

Authors and Affiliations

  1. Institute of Clinical Orthopedics and Neurosciences, Desert Regional Medical Center, 1180 N Palm Canyon Drive, Suite 201, Palm Springs, CA, 92262, USA

    Douglas J. Roger MD & David Hill PA‐C

Authors
  1. Douglas J. Roger MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Hill PA‐C
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Douglas J. Roger MD.

Additional information

One of the authors certifies that he (DJR), or a member of his immediate family, has or may receive payments or benefits, in any 1 year, an amount in excess of $100,000.00 from a commercial entity (Greatbatch Medical, Clarence, NY, USA) related to this work. One of the authors certifies that he (DJR), or a member of his immediate family, has patent/licensing arrangements with Greatbatch Medical.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

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.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Video 1 (MPG 16148 kb)

Video 2 (MPG 17175 kb)

Video 3 (MPG 13326 kb)

Video 4 (MPG 15250 kb)

Video 5 (MPG 21128 kb)

Video 6 (MPG 23801 kb)

Video 7 (MPG 32174 kb)

Video 8 (MPG 15170 kb)

About this article

Cite this article

Roger, D.J., Hill, D. Minimally Invasive Total Hip Arthroplasty Using a Transpiriformis Approach: A Preliminary Report. Clin Orthop Relat Res 470, 2227–2234 (2012). https://doi.org/10.1007/s11999-011-2225-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-011-2225-z

Keywords

Search

Navigation