Total Hip Arthroplasty Using the Minimally Invasive Two-Incision Approach

A new approach to total hip replacement, a minimally invasive two-incision technique, was developed; one incision is used for the acetabular component and the other incision is used for the femoral component. The first 100 minimally invasive two-incision THAs done at my hospital are reported. The complication rate in the first 100 cases was 1%: one proximal femoral fracture. There have been no dislocations, no failure of ingrowth, no reoperations, and no other complications. After the first 12 cases, an outpatient protocol was initiated. In the subsequent 88 patients, 75 patients (85%) chose to go home the day of surgery and 13 patients (15%) chose to go home the day after surgery. All patients were discharged to home, not to other care facilities. There were no readmissions and no complications after discharge. Radiographic analysis of the first 30 patients showed 91% of the femoral stems in neutral alignment (range, neutral -3 degrees valgus). The abduction angle for acetabular components averaged 45 degrees (range, 36 degrees-54 degrees). No component migrated or failed to show ingrowth. This two-incision minimally invasive THA technique was shown to be safe and facilitated a rapid patient recovery; however, this technique is technically challenging and only should be attempted after proper hands-on training.