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. 2007 Aug;31 Suppl 1(Suppl 1):S25-8.
doi: 10.1007/s00264-007-0432-8.

Making minimally invasive THR safe: conclusions from biomechanical simulation and analysis

P C Noble  1 , J D Johnston, J A Alexander, M T Thompson, M M Usrey, E M Heinrich, G C Landon, K B Mathis
Affiliations

Making minimally invasive THR safe: conclusions from biomechanical simulation and analysis

P C Noble et al. Int Orthop. 2007 Aug.

Abstract

The use of smaller surgical incisions has become popularized for total hip arthroplasty (THR) because of the potential benefits of shorter recovery and improved cosmetic appearance. However, an increased incidence of serious complications has been reported. To minimize the risks of minimally invasive approaches to THR, we have developed an experimental approach which enables us to evaluate risk factors in these procedures through cadaveric simulations performed within the laboratory. During cadaveric hip replacement procedures performed via posterior and antero-lateral mini-incisions, pressures developed between the wound edges and the retractors were approximately double those recorded during conventional hip replacement using Charnley retractors (p < 0.01). In MIS procedures performed via the dual-incision approach, lack of direct visualisation of the proximal femur led to misalignment of broaches and implants with increased risk of cortical fracture during canal preparation and implant insertion. Cadaveric simulation of surgical procedures allows surgeons to measure variables affecting the technical success of surgery and to master new procedures without placing patients at risk.

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Figures

Fig. 1
Fig. 1
Typical view of a posterior mini-incision showing the tattooed grid and the pattern of skin displacement
Fig. 2
Fig. 2
Fluoroscopic images of broach malalignment during dual-incision MIS procedures
See this image and copyright information in PMC

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