Mayo Experience with Two-Incision Total Hip Arthroplasty: The Added Technical Difficulty Has Not Been Rewarded

Minimally invasive (MIS) two-incision total hip arthroplasty (THA) was initially described as a revolutionary approach to total hip replacement in which no muscles or tendons were cut. Surgeon-developers of the MIS two-incision THA reported rapid recovery with few complications in highly selected groups of patients. However, there were no comparative studies reported by the surgeon-developers comparing the two-incision approach to any other method of THA in similar groups of patients using the same advanced anesthetic and rehabilitation protocols. At the Mayo Clinic our step-by-step research approach concerning MIS two-incision THA has included anatomical and clinical studies evaluating muscular damage, intraoperative and postoperative complications, subjective results, and functional results based on objective measurements including comprehensive gait analysis and strength testing. Our analysis of the accumulated data suggests that there are no scientific data that the two-incision technique provides better functional results than other approaches to THA, for many surgeons the prevalence of complications is high, the technique cannot be done without routinely damaging the abductor muscles, and patients who have had a THA with both techniques preferred a miniposterior THA to the two-incision THA.

Keywords: two-incision THA, comparative study, muscle damage