Total Hip Arthroplasty Through a Minimally Invasive Anterior Surgical Approach

Total hip arthroplasty has become one of the most frequently performed and successful reconstructive procedures in orthopaedic surgery since its introduction more than forty years ago1. While there have been many changes in implant designs and biomaterials, surgical approaches have remained relatively unchanged over the years. Recently, in response to the evolution of minimally invasive procedures such as angioplasty, laparoscopic abdominal surgery, and arthroscopy, orthopaedic surgeons have expressed an increased interest in minimally invasive surgical approaches to total hip arthroplasty. A variety of surgical approaches have been utilized for the performance of total hip arthroplasty; these include anterior, anterolateral, direct lateral, transtrochanteric, and posterior techniques2-11. The modified anterior approach developed by one of us (K.J.K.) provides effective access to the hip through a small incision and the use of secondary incisions for acetabular and/or femoral instrumentation (Fig. 1)12,13. This surgical approach has been utilized by the three senior authors (K.J.K., J.M.K., and R.S.W.) in more than 6000 total hip arthroplasties over the past thirty years. The purpose of this report is to present the perioperative clinical parameters and short-term clinical outcomes documented in our extensive patient database established twenty years ago. Fig. 1 Performance of an anterior approach for total hip arthroplasty with a one, two, or three-mini-incision technique depends on the surgical profile of the patient. ### Patient Positioning The operating table is oriented at right angles to the walls to provide the surgeon with accurate references for anatomical orientation. The patient is positioned supine with the axis of the pelvis at a right angle to the long axis of the table (Fig. 2). The uninvolved lower limb is abducted and is placed on an arm board extending beyond the edge of the operating table in order to allow for adduction of the …