Anterolateral Mini-incision Hip Replacement Surgery: A Modified Watson-Jones Approach

Mini-incision total hip replacement seeks to eliminate some complications of traditional extensile exposure and also attempts to facilitate more rapid rehabilitation of patients after surgery. Different surgical approaches historically have been used to do hip replacement surgery. Anterior or anterolateral approaches have often been selected to decrease the risk of posterior dislocation. Traditional anterolateral approaches have divided the anterior portion of the gluteus medius and minimus and potentially jeopardized the superior gluteal nerve. These disadvantages have been associated with abductor weakness, prolonged limp and decreased patient satisfaction. To overcome these problems, a mini-incision approach was developed using the intermuscular plane between the gluteus medius and the tensor fascia lata. This intermuscular interval through a small incision provides good exposure for total hip replacement and preserves muscle integrity so that rehabilitation can be rapid and the posterior capsule remains intact so that posterior dislocation is less of an issue. The surgical technique for this new innovative approach is described in this article.