Purpose: Authors introduce short term results, hazards and solutions of 52 minimally invasive total knee replacement performed in their institute. Aspects of minimally invasive and minimalised exposures are detailed with differences in indication .

Methods: Starting in June 2004 52 minimally invasive total knee replacements were performed in authors institute. The technique is quadriceps sparing, the implants are placed in through a medial parapatellar MIS incision. Types of vastus medialis insertion are crucial in indication of MIS or minimalised total knee. Preparation of the surfaces needs careful preparation, precise instrumentation and skill. Following patellar resection alignment, ligament balance should be treated as important and accurate as with other techniques. No muscles and tendons are detached Neurovascular hazards, complications, difficulties with solutions are introduced. Indication is determined by pathoanatomy and weight of the patient. Malalignment shouldn’t exceed 10–15 degrees. Flexion contracture more than 10 degrees is contraindication of the technique.

Depending on the type of vastus insertion midvastus approach was used with good results in 8 cases .

Results: The operation performed on properly selected patients results in a good implantation with appropriate ligament balance and stability. Average flexion was 74 degrees in the first two post op days. Post operative pain was significantly reduced. Hospital stay was 3,1 days. There was no infection. Conversion to normal exposure was done in 3 cases. In 8 cases midvastus approach was preferred because of anatomy.

Conclusions: Minimally invasive total knee replacement is technically more demanding, requiring adequate training and knowledge. Appropriate indication is inevitable. Hospital stay and rehabilitation time is reduced also resulting in economic benefit, though never compromising good result of TKR.

Purpose: Authors introduce short term results, hazards and solutions of 250 two incision MIS hip replacement performed in their institute. Aspects of one incision techniques are detailed with differences in indication .

Methods: Between April 2003 and September 2004 250 two-incision minimally invasive total hip replacements were performed in authors institute. The cup and the stem is implanted through two incisions using physiological muscle route between m. sartorius and m. tensor fasciae latae and the m.rectus femoris and the m. gluteus medius. Preparation of the stem is done through an incision made above the greater trochanter through a gluteus maximus split straight done to the piriformis fossa. No muscles and tendons are detached Neurovascular hazards, complications with solutions are introduced. Indication is determined by pathoanatomy and weight of the patient. 115 osteoarthritis, 72 aseptic necrosis, 57 dysplastic and 6 posttraumatic patients were operated.

Results: The operation performed on properly selected patients results in increased primary stability, because of preserving structures like the iliotibial tract, muscles and the iliofemoral ligament, causing minimal soft tissue damage. There was no dislocation. Radiological analysis revealed more than 3 degrees malalignment in 3,7 % for stem and in 5,1% for cup. Fluoroscopy and OP time was reduced to av. 6 secs. Average flexion was 76 degrees in the first two post op days. Post operative pain was significantly reduced. Hospital stay was 3,2 days. There was no infection, nor heterotopic ossification. In 5 cases the femur fractured and wiring was necessary through the anterior incision. 1 revision for cemented stem was necessary because of stem migration due to extreme size of femur . Conversion to lateral exposure was done in one case.

Conclusions: Two incision minimally invasive total hip replacement is technically more demanding, requiring adequate training and knowledge. Appropriate indication is inevitable. Hospital stay and rehabilitation time is reduced also resulting in economic benefit, though not compromising good result of THR.