updated 10/8/2023 tpg

It is logical that implanting the artificial joint implants with minimal collateral damage to the soft tissues and bone is desirable for quicker healing and a better outcome. The problem is that smaller incision surgery is more complicated for the surgeon and can lead to more errors if the surgeon does not have the necessary technical skills. Therefore scientific studies have sometimes shown worse outcomes for minimally invasive surgery. Many claims for quicker recovery with certain techniques are not substantiated by results. In this arena it is impossible to make general claims of superiority of any technique. Results more dependent on the individual surgeon than the specific technique. You must carefully look at an individual surgeon’s published track record to make a judgment.

When we started performing minimally invasive resurfacing, we compared our results to our previous outcome with larger surgical approaches and found them to be superior without any higher risk of complication and published this. We have used a minimally invasive posterior approach for all hip surgeries since 2005.

Most hip resurfacings in the world are performed through a large posterior approach using a 8-12 inch incision. I use a minimally invasive 4-5 inch approach.

The next most common approach is the anterolateral approach. I do not prefer this approach because it requires detachment of a portion of the abductor muscles. Sometimes these don’t heal perfectly leaving a permanent limp and this is hard to fix later. There is no scientific study to prove my opinion on this matter.

The direct anterior approach has become fashionable in total hip replacement. The claim is a lower dislocation rate and a quicker recovery. There is some evidence to support the first claim for small bearing total hip replacements, but if large metal bearings are used, the dislocation rate is almost zero through a posterior approach. The claim of faster recovery is not supported by evidence. I believe the mini posterior approach has a similar recovery rate. There is now one published paper on hip resurfacing through a direct anterior approach Dr Paul Beaule reports a 93% 10-year implant survivorship with this technique, while I report a 99% 17-year implant survivorship with the mini posterior approach. Additionally, I know several surgeons who have used this approach and I am aware of three presentations at meetings. One did not give data, the other two had a very high rate of early complications. For now I think we should stick to the proven method.