Minimally invasive surgery for total hip arthroplasty

We review recent publications (primarily January, 2007 through July, 2008) and describe the development of minimally invasive techniques and protocols for total hip arthroplasty. The main themes are the short-term outcome differences between standard and minimally invasive surgical approaches and between two types of minimally invasive surgical approaches: the mini-posterior and two-incision approach. Some investigators contend that outcome depends on choice of surgical approach alone; others have found that outcome is more attributable to perioperative protocols. The distinction between minimally invasive and mini-incision surgery continues to be clarified. The literature indicates that (1) patient expectations, anesthetic modality and rapid rehabilitation protocols may affect recovery time more than the type of surgical approach or length of skin incision; (2) deep dissection plays more of a role in recovery than the length of skin incision; and (3) the differences in outcomes related to the type of minimally invasive surgical approach remain undistinguished. However, patients and surgeons continue to believe that smaller incisions lead to better outcomes. Additional investigation is needed to identify the best approach and to delineate the specific roles of expectations, pain control and rapid rehabilitation.