Over the years, techniques for hip replacement surgery have evolved to minimize tissue trauma and enhance patient outcomes. The longer incisions and prolonged hospital stay of previous decades have given way to smaller incisions and rapid mobilisation. The minimally invasive posterior approach is part of this evolution. It is now my preferred technique and in my view has distinct advantages compared to other approaches. Combined with an enhanced recovery pathway it enables rapid recovery with less pain and some patients can even go home within 24 hours as shown in this video:
Understanding the Minimally Invasive Posterior Approach:
- The minimally invasive posterior approach involves accessing the hip joint through a small incision made in the posterior (back) region of the hip. Unlike the traditional approach, this technique spares major muscles and tendons, resulting in reduced tissue damage and faster recovery. It also provides surgeons with an excellent view of the hip joint, allowing for precise implant placement and alignment.
- During the surgery, the patient is positioned on their side, and a small incision, typically 10-12 centimeters in length, is made in the buttock area. The surgeon carefully separates the gluteal muscles. The main external rotator muscle called the piriformis is preserved. A tiny tendon adjacent to this is detached from the bone and repaired later. The damaged bone and cartilage are then removed, and the artificial hip components are implanted.
Benefits of the Minimally Invasive Posterior Approach:
- Reduced Tissue Trauma: By sparing major muscles and tendons, the procedure minimizes tissue disruption, leading to decreased postoperative pain and blood loss compared to traditional approaches.
- Smaller Incision and Scar: The smaller incision results in a cosmetically appealing scar, and it reduces the risk of wound complications such as infection.
- Faster Recovery: Patients undergoing the minimally invasive posterior approach typically experience a shorter hospital stay, faster mobilization, and quicker return to daily activities compared to traditional approaches.
- Lower Dislocation Risk: The minimally invasive posterior approach has shown reduced dislocation rates, contributing to improved patient satisfaction and reduced revision surgery rates. Most importantly this means that the onerous restrictions placed on patients to prevent dislocation are no longer required. Patients can sleep and sit however is comfortable immediately after the surgery.
- Comparable Long Term Clinical Outcomes: Numerous studies have demonstrated comparable long term outcomes, including pain relief and functional improvement, between the minimally invasive posterior approach and traditional approaches.
The minimally invasive posterior approach represents a significant advancement in patient care. By safely minimizing tissue trauma, reducing pain and recovery time, and enhancing implant stability, this technique has revolutionized the field of hip arthroplasty. It is of course important to consult with a qualified orthopaedic surgeon to determine the most appropriate surgical approach for you based on their experience and your individual characteristics and needs.
For a comparison to the anterior approach click here.
For more information on hip replacement surgery click here.
If you would like to discuss hip replacement surgery with Dr Bauze then send us an email using the form on this page or call 81301259.
References
- Wang T, Zhou Y, Li X, Gao S, Yang Q. Comparison of postoperative effectiveness of less invasive short external rotator sparing approach versus standard posterior approach for total hip arthroplasty. J Orthop Surg Res. 2021 Jan 11;16(1):46
- Wainwright TW, Gill M, McDonald DA, Middleton RG, Reed M, Sahota O, Yates P, Ljungqvist O. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Acta Orthop. 2020 Feb;91(1):3-19
- Siddappa VH, Meftah M. Piriformis-Sparing Technique in Total Hip Arthroplasty with Posterolateral Approach. Surg Technol Int. 2020 May 28;36:360-363.
- Tan BKL, Khan RJK, Haebich SJ, Maor D, Blake EL, Breidahl WH. Piriformis-Sparing Minimally Invasive Versus the Standard Posterior Approach for Total Hip Arthroplasty: A 10-Year Follow-Up of a Randomized Control Trial. J Arthroplasty. 2019 Feb;34(2):319-326.
- van der Weegen W, Kornuijt A, Das D. Do lifestyle restrictions and precautions prevent dislocation after total hip arthroplasty? A systematic review and meta-analysis of the literature. Clin Rehabil. 2016 Apr;30(4):329-39.
- Berstock JR, Blom AW, Beswick AD. A systematic review and meta-analysis of the standard versus mini-incision posterior approach to total hip arthroplasty. J Arthroplasty. 2014 Oct;29(10):1970-82.
- Ginnetti JG, Erickson J, Peters CL. Total hip arthroplasty: the mini-posterior approach. Instr Course Lect. 2013;62:237-43.
- Sculco TP, Boettner F. Minimally invasive total hip arthroplasty: the posterior approach. Instr Course Lect. 2006;55:205-14
- Chung W, Liu D, Foo L. Mini-Incision Total Hip Replacement—Surgical Technique and Early Results. Journal of Orthopaedic Surgery. 2004;12(1):19-24
