THE JOURNAL OF BONE & JOINT SURGERY
VOLUME 85-A · SUPPLEMENT4 · 2003
Minimal-Incision Total Hip Arthroplasty
BY WAYNE M. GOLDSTEIN, MD, JILL J. BRANSON, RN, BSN,
KIMBERLY A. BERLAND, CST, FA, AND ALEXANDER C. GORDON, MD
Objective:
The purpose of this study is to present the experience with total hip arthroplasty
performed through a minimal incision.
Materials and Methods:
 Retrospectively of 170 total hip, 85 hips in 76 patients (the minimal-incision group),
85 hips in 78 patients (the standard-incision group).
 Preoperative Blood Product Protocol
 All patients scheduled for unilateral total hip arthroplasty donated one or two units of
autologous blood.
 Individuals scheduled for bilateral total hip arthroplasty donated three units of autologous
blood.
 Operative Technique
 For the standard-incision technique, a posterolateral approach to the hip was performed
with use of a standard-length (12 to 24-in [30 to 61-cm]) curved incision.
 The minimal-incision technique is begun with an incision 2 cm posterior and 2 cm
proximal to the apex of a standard incision, angled from the flare of the greater trochanter
to the posterior superior iliac spine.
 Warfarin therapy for thromboembolic prophylaxis was started on the evening of the
surgery, and a complete blood-cell count was done daily for the first three postoperative
days.
 Data Collection:
 Demographic information, laboratory values, postoperative clinical course were
determined, component type, estimated blood loss, length of the skin incision, operative
time and the type and amount of blood products transfused.
 Clinical Evaluation:
 Physical examinations consisting of evaluation of the wound and measurement of the
range of motion were performed at all visits.
 Statistical Analysis
 Unpaired t tests were used to compare continuous variables in normally distributed data
between groups.
 The Pearson chi-square and Fisher exact tests were used to compare categorical data, such
as transfusion status.
Result:
 Patients
 Differences between groups with regard to weight and body-mass index (p = 0.0001) not
to patient age or height (p = 0.30 and 0.16, respectively).
 Operative Data:
 There was a significant difference in the estimated blood loss at surgery between the
standard-incision group (408 mL) and the minimal-incision group (273 mL) (p = 0.0001).
 Perioperative Blood Data
 No significant difference between groups with respect to preoperative hemoglobin level (p
= 0.44).
 A significant difference between groups with regard to the absolute hemoglobin level on
postoperative day one (98 g/L in the minimal-incision group and 102 g/L in the
standard-incision group; p = 0.05).
 Categorical Data
 Sixty-five percent of the patients in the minimal-incision group and 56% in the
standard-incision group required postoperative blood transfusions (p = 0.31, Fisher exact
test).
 Eleven percent of the patients who had a transfusion in the minimal-incision group.
 7% of such patients in the standard-incision group also required allogenic blood after
infusion of the autologous units.
 Component Position
 The mean abduction angle of the cup was 47° (range, 38° to 56°).
 Two femoral components were in varus alignment; the rest were in neutral.
 Clinical Evaluation
 Patient satisfaction was high in both groups.
 no significant differences between the minimal-incision and standard-incision groups with
regard to the Harris hip scores preoperatively.
 Complications
 There were seven wound complications, five in the standard-incision group and two in the
minimal-incision group.
 All seven of these complications involved prolonged serous drainage.
 Six resolved with wound care and administration of oral antibiotics.
 The seventh, in a patient in the standard-incision group, required irrigation and
débridement with a short period of intravenous antibiotics.
 Obese Patients Treated with Minimal-Incision Technique:
Discussion:
 It is clear from those study data that the minimal-incision technique is not a minimally
invasive operation. This is reflected by the fact that failed to find a difference between
groups with regard to various postoperative parameters.
 The term minimally invasive must be used with caution, as a smaller skin incision does
not necessarily mean less pain or faster rehabilitation.