Minimally Invasive Two-Incision Total Hip Arthroplasty: Is the Second Incision Necessary?

This article refutes the need for the posterior incision in minimally invasive two-incision total hip replacement. A description of how the Smith-Petersen, direct anterior, approach can be used to expose and implant the femoral components is given. Data from a prospective comparison of direct anterior and modified Hardinge approaches is presented. Seventy-nine patients in matched groups were analyzed. There was no difference between the groups in average body mass index, surgical time, incision length, hospital stay, pain, blood loss, or complications. At the six-month follow up evaluation slightly better outcomes were seen for the direct anterior approach when compared to the direct lateral approach. Limiting exposure to the anterior incision eliminates soft tissue and muscular damage. Other concerns such as intraoperative fractures, stem malpositioning, and prolonged surgeries are not seen with the direct anterior technique. Minimally invasive total hip arthroplasty can be performed safely with excellent results using the direct anterior incision alone.