japanese hip society

The purpose of minimally invasive surgery(MIS) is to make tissue injury as little as possible during surgery enabling the patients recover quickly. Even though there has been some controversies regarding the advantages and the risks of the MIS, a great effort has been made to reduce the injury of normal tissues in the hip arthroplasty during the last 20 years. The potential benefits of MIS total hip arthroplasty are better cosmesis because of small incision, less trauma, less blood loss, less pain, better psychologic safety, less complication such as DVT and pulmonary embolism, quicker recovery, early return to work, and better quality of function. The potential disadvantages are difficult exposure, increased surgery time, difficulty of using cemented type, more complication like component malposition, fracture, nerve palsy and skin sloughing, and difficult learning curve for beginner surgeons. The methods of MIS-THA can be divided into 2 categories; One-incision MIS-THA and Two-incision MIS THA. In my personal experience, one-incision MIS THA(posterolateral approach) mainly decreased the size of skin incision and slightly decreased the injury of muscle, tendon, capsule and ligament. However, two-incision MIS-THA mainly decreased the injury of muscles which is very important for low dislocation, early rehabilitation and better function. Overall, I believe that two-incision MIS-THA provides better function for the hip on the condition that the surgery is well performed by the experienced surgeon. Therefore, my routine primary total hip arthroplasty technique recently is a modified two-incision MIS-Total hip arthroplasty that was developed by myself. The surgery can be performed safely with acceptable rate of complications in the hands of well-trained surgeon. The biggest disadvantage of this technique is long learning-curve for the surgical technique. If the learning-cure is overcome, this technique provides the patients much more stability and satisfaction due to the preservation of muscles surrounding the hip joint.