Minimally Invasive Posterior Approach for Hip Resurfacing Arthroplasty

Summary: With the improvement of metal-on-metal bearings, hip resurfacing has become a viable option for hip arthroplasty in young patients. It is technically more complicated to gain access to the acetabulum while preserving the femoral head. In some countries, this type of bone-preserving hip arthroplasty is used in a substantial percentage of young patients. Little formal instruction exists in most US orthopaedic training programs for this procedure. After gaining experience with over 2000 hip resurfacing arthroplasties (HRA), we describe a technique for performing this operation using a minimally invasive surgical (MIS) technique based on the posterior approach. The Biomet instrumentation was designed to facilitate an MIS technique, but other systems can also be adapted to this technique. Some custom retractors are also described that are critical. Detailed technical instructions are given to help the reader improve his/her results and avoid complications while learning to perform HRA. A prospective analysis has demonstrated improved clinical results and no increased complications when employing MIS techniques for HRA using a posterior approach.