Minimally Invasive Surgery: The Issues: Minimal Single Incision Posterior THA

Current literature supports the concept that limited tissue trauma is more important than the length of the incision. Pain management and a comprehensive approach to rehabilitation can improve and accelerate the outcome with any approach to the hip. Thus, the ideal approach to the hip should allow customization of the incision length to achieve optimal implant placement through the smallest possible incision for a given patient anatomy. The single posterior incision provides access to the hip joint with maximal visualization and limited tissue trauma. Advantages include the lateral position, which moves soft tissue away from the surgical field, incision placement through gluteal skin away from large cutaneous nerves, and avoidance of the gluteus medius muscle. Access is achieved by longitudinal splitting of the gluteus maximus muscle at the interval between its middle and posterior third. The approach proceeds through the interval between the piriformis and gluteus minimus muscle. A capsulotendinous flap is created, the hip is dislocated posteriorly, and the femoral neck is osteotomized. The acetabulum is exposed by translating the femur forward with a retractor placed under the femoral neck and over the anterior rim of the acetabulum. The short oblique posterior incision was developed in conjunction with anatomic dissections used to define the optimal incision placement for a capsular incision that would preserve the ischiofemoral ligament of the hip capsule.