The Journal of Bone and Joint Surgery (American). 2005;87:2432-2438.
doi:10.2106/JBJS.D.02847
© 2005 The Journal of Bone and Joint Surgery, Inc.
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Adult Hip Reconstruction Test 17: Winter 2006
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Early Complications of Primary Total Hip Replacement Performed with a Two-Incision Minimally Invasive Technique

B. Sonny Bal, MD, MBA1, Doug Haltom, MD1, Thomas Aleto, MD1 and Matthew Barrett, MD1

1 Department of Orthopaedic Surgery, School of Medicine, University of Missouri, MC213, DC053.00, One Hospital Drive, Columbia, MO 65212. E-mail address for B.S. Bal: balb{at}health.missouri.edu

Investigation performed at the Department of Orthopaedic Surgery, School of Medicine, University of Missouri, Columbia, Missouri

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from Zimmer. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Total hip replacement performed through a small incision theoretically results in less trauma to the underlying structures, reduced blood loss, less pain, and a shorter hospital stay, but it may result in increased complications, particularly early in a surgeon's experience with a new technique. In the present study, we reviewed the early results of two techniques involving the use of smaller incisions; specifically, we evaluated one series of primary total hip replacements that had been performed through two small incisions and another series of total hip replacements that had been performed through a single small incision.

Methods: Eighty-nine consecutive primary total hip replacements were performed with use of the two-incision technique as described by Mears and Berger; all procedures were performed without cement and with use of fluoroscopic guidance. Outcomes data were reviewed at a minimum of six months following the procedure. The results of these procedures were retrospectively compared with those of a historical control series of ninety-six total hip replacements that had been performed by the same surgeon with use of a single mini-incision technique. No special attempt was made to discharge any patient early from the hospital. In preparation for the use of the two-incision technique, the surgeon attended a two-day seminar that included cadaveric training and mentoring by surgeons who had experience with this technique.

Results: In the two-incision group, nine patients (nine hips; 10%) required repeat surgery because of a femoral fracture that had been identified postoperatively (two hips), dislocation (one hip), a wound complication (two hips), or subsidence and loosening of the femoral implant (four hips). Twenty-two patients (twenty-two hips; 25%) sustained an injury of the lateral femoral cutaneous nerve, and one patient (one hip) had a neuropraxia of the femoral nerve. In the comparative series of ninety-six total hip arthroplasties that had been performed with use of a single mini-incision and a direct lateral exposure of the hip joint, the overall complication rate was 6% (six of ninety-six) and the reoperation rate was 3% (three of ninety-six). The rate of complications associated with the two-incision technique decreased significantly as the surgeon gained experience with the procedure (p = 0.0202).

Conclusions: Although total hip arthroplasty with use of the two-incision technique was performed by a surgeon who was experienced in the performance of total hip replacement surgery with use of a single small incision, the rates of complications and repeat surgery associated with the two-incision technique initially were very high. While the rate diminished with increasing experience, total hip replacement with use of two incisions and fluoroscopic guidance is a technically demanding procedure that may be associated, especially initially, with higher rates of complications and repeat surgery.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.


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Letters to the Editor:

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Complication Rate of Two Incision Minimally Invasive THA
Steven T. Woolson
JBJS Online, 17 Nov 2005 [Full text]
Primary THA with a Two-Incision Minimally Invasive Technique
B. Sonny Bal, et al.
JBJS Online, 17 Nov 2005 [Full text]