Tissue-Preserving, Minimally Invasive Total Hip Arthroplasty Using a Superior Capsulotomy

Conventional total hip arthroplasty in its many forms has been well established as a reliable procedure with predictable recovery. The high volume of procedures has allowed the incidences of the most common post-operative complications to be determined. Early complications vary widely by surgical approach and method of fixation, but generally include infection, dislocation, abductor morbidity, intra-operative fracture, and, rarely, nerve palsy. Preliminary reports of total hip arthroplasty using minimally invasive techniques have shown a tendency towards higher, rather than lower, complication rates [1, 6, 17, 19, 20]. Reasonable goals for evolving total hip arthroplasty include reducing the incidence of these peri-operative complications while simultaneously accelerating recovery. The incidences of complications following conventional total hip arthroplasty depend largely on the surgical approach used to perform the procedure.  THA performed using a posterior exposure may be complicated by post-operative dislocation [10, 18].  THA performed using a direct lateral exposure may be complicated by incomplete abductor muscle recovery [5, 15].  THA performed using a trans-trochanteric exposure may be complicated by trochanteric non-union and dislocation [16].  THA performed using an anterior exposure may be complicated by abductor muscle injury and difficulty instrumenting the femur [6, 8, 9].