Minimally Invasive Total Hip Arthroplasty Periprocedural Care

  • Author: Derek F Amanatullah, MD, MS, PhD; Chief Editor: Erik D Schraga, MD   more...
 
Updated: Dec 20, 2011
 

Patient Education and Consent

It is imperative to ensure appropriate patient education before either conventional total hip arthroplasty (THA) or minimally invasive THA (MIS-THA). Such education should address the patient’s postoperative expectations, as well as inform the patient regarding the administration of anticoagulation. Preoperative counseling with respect to the patient’s postoperative activity level is left to the discretion of the surgeon.

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Preprocedural Planning

Preoperative evaluation and preparation for MIS-THA are exactly the same as they would be for conventional THA, except for the specialized surgical instrumentation and implants involved in the minimally invasive technique. Because exposure may be limited, MIS-THA may necessitate modification of conventional instrumentation and possibly the use of additional equipment (eg, fiberoptic light cables, cutaway reamers, Hohmann retractors with light sources, or flexible acetabular reamers).[15, 16, 17]

Particular operating room tables make certain MIS-THA approaches more accessible and may be required to provide the requisite traction and permit rotation of the lower extremity. For example, a Judet Orthopaedic Table (Tasserit, Sens, France) or a PROfx Fracture Table (OSI, Union City, CA) can facilitate an anterior approach, and a Jupiter Table (Trumpf, Charleston, SC) may be especially suitable for an anterolateral approach.[16, 18, 19]

Preoperative templating may be employed to guide the determinations of component and incision sizes. For example, a 4-in. incision would be appropriate for inserting a size 56 acetabular component while avoiding contact between the prosthesis and skin or subcutaneous fat.[2]

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Contributor Information and Disclosures
Author

Derek F Amanatullah, MD, MS, PhD  Dr Denny and Jeanene Dickenson Orthopedic Research Fellow, Resident Physician, Department of Orthopedic Surgery, University of California, Davis, School of Medicine

Derek F Amanatullah, MD, MS, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, California Orthopedic Association, and Orthopaedic Research Society

Disclosure: Nothing to disclose.

Coauthor(s)

Paul E Di Cesare, MD, FACS  Professor and Chair, Department of Orthopedic Sugery, University of California, Davis, School of Medicine

Paul E Di Cesare, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, and Sigma Xi

Disclosure: Stryker Consulting fee Consulting

Chief Editor

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

References

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Skin incisions for anterior (light blue), miniposterior (dark blue), and conventional posterior (red extensions to dark blue) approaches to hip. Conventional posterior incision is usually 10 to 25 cm long (red extensions). Single mini-incision is usually less than 10 cm long (blue). In 2-incision approach, 2 incisions (blue) are each usually less than 5 cm long.
 
 
 
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