MINIMAL INVASIVE THR SURGERY VIA THE POSTERIOR APPROACH

Abstract

Introduction and Aims: Minimal Invasive Surgery (MIS) in THR surgery offers potential advantages over standard techniques. A user-friendly surgical technique has been developed via the posterior approach to the hip using a single six to eight centimetre incision, and requiring no special instrumentation other than three long Homan retractors of standard design. The technique has been used to date in 80 sequential non-obese patients undergoing both uncemented and cemented THRs.

Method: Five cemented and 75 uncemented THR procedures were performed in the lateral position via a segment of the standard posterior approach incision, centred just behind the greater trochanter. The pre- and post-operative SF12, WOMAC, Harris hip score and Pain score were assessed prospectively; blood loss, theatre time and intra-operative and post-operative complications were charted, and compared with 40 matched standard incision patients. Cup and stem component positioning was assessed radiologically. The Body Mass Index (BMI) and the incision length were charted in each patient. The post-operative time to full weightbearing and stair climbing was charted.

Results: There was no statistical difference in SF12, WOMAC, Harris hip score and Pain score in the two groups of patients. Blood loss was slightly reduced, but theatre time and intra-operative and post-operative complications were not increased. Cup and stem positioning on x-ray was not compromised. Immediate full weightbearing was allowed, including stair climbing post-operatively in all patients.

Conclusion: MIS THR via the posterior approach is a safe and reproducible procedure, for both cemented and uncemented prostheses. It requires no special instrumentation or long learning phase for the experienced hip surgeon. Blood loss, theatre time and morbidity have not been increased, allowing a rapid discharge program as a routine.