Introduction: Total hip arthroplasty preformed with the use of minimal incision surgery has received tremendous attention recently. Various surgical approaches have been introduced to minimize surgical trauma to the soft tissues. The mini invasive Modified Watson-Jones approach have been selected to decrease the perioperative complications associated with other mini invasive approaches that has been described.

The anterolateral mini incision is a new innovative approach using the intramuscular plan between the gluteus medius and the tensor fascia lata. This intermuscular interval through a small incision provides good exposure and preserves muscle integrity. Moreover, preserving the muscle integrity provides a very stable joint after implantation such that no restrictions is giving to the patient during the rehabilitation period.

Materials and Methods: Between July 2004 to September 2005, we used this approach on 60 sequential patients. Fifty patients were enrolled in this prospective study. Patients were evaluated preoperatively, immediately postoperatively, and at 3-month and 6 month follow-up according to operating time, intraoperative blood loss, subcutaneous drains blood loss, post op pain control drugs requirements, short form 36 patient questionnaire (SF-36) scores and the Harris Hip Score (HHS). 4 patients had previous THA on the contralteral side.

Results: The average operation time was 137min (range 90–200min), there were no dislocations, the mean post operation blood transfusion requirements was 1.64, the mean subcutaneous drains blood loss was 241.9ml (range 20–620ml), there was significant improvement in function, pain, SF-36 and Harris Hip Score (HHS) at the 3-month and 6-month follow-up examination. The average length of the incision was under 12cm. We had one reoperation due to deep infection. All four patients with bilateral THA preferred their last operation due to lack of post operative restrictions and due to shorter recovery of muscle strength.

Conclusion: We think that using mini invasive Modified Watson-Jones approach in total hip replacement surgeries is a preferable option. There are several advantages of using this approach compared with the more traditional techniques. Such a technique should help reduce morbidity and complication rates for those patients undergoing a total hip replacement.

Introduction and Aims: The incidence and technical complexity of revision total hip arthroplasty (THA) has and will continue to increase dramatically. We report the results of revision THA using a non-cemented, dual threaded, cone shaped, (DTCS) modular femoral component.

Method: Between June of 1999 and July of 2003, 41 revision THAs using a DTCS modular femoral component. Fifty-four percent of the patients were male and 46% were female with an average weight of 84kg (std dev: 30kg, range 57–60 kg), an average height of 170cm (sdt dev: 9cm, range: 155–182 cm) and an average body mass index (BMI) of 26 (std dev: 4, range: 18–31). The average patient age was 71 years (std dev: 12 years, range: 39–85 years).

Results: The average patient follow-up was 16 months (range 6–49 months). The average Harris hip score (HHS) at the most recent time to follow-up was 76. Broken into the HHS component parts, the average pain score was 40 of a possible 44, average motion was nine of a possible nine, and average function was 28 of a possible 47. Radiographic evaluation revealed wellfixed and positioned components with evidence of bone densing in areas in intimate contact with the DTCS component. Radiographic evidence of minor stress shielding was observed in the greater trochanter (Gruen Zone 1) and the proximal calcar/neck cut region (Gruen Zone 7). Post-operative complications included recurrent infection in four (10%), subsequently resolved with IV antibiotics; dislocation in three (7%), successfully treated by closed reduction and protective bracing; aseptic loosening in one (2%), with femoral component revision to a larger size; intra-operative periprosthetic fracture in one (2%), treated with ORIF (bone, plate and screws); and a non-union of a pre-revision fracture with subsequent component loosening in one (2%). Regardless of the degree of femoral deficiency, there was no incidence of component disassociation or component fracture.

Conclusion: Revision THA is a demanding undertaking and involves multivariate technical challenges that may include mechanical and material considerations such as prosthetic loosening, prosthetic and periprosthetic fracture. We show that the use of a DTCS modular femoral component affords the surgeon results equal to those reported for revision THA and allows intra-operative versatility independent of bone quality.

Introduction and Aims: Minimal Invasive Surgery (MIS) in THR surgery offers potential advantages over standard techniques. A user-friendly surgical technique has been developed via the posterior approach to the hip using a single six to eight centimetre incision, and requiring no special instrumentation other than three long Homan retractors of standard design. The technique has been used to date in 80 sequential non-obese patients undergoing both uncemented and cemented THRs.

Method: Five cemented and 75 uncemented THR procedures were performed in the lateral position via a segment of the standard posterior approach incision, centred just behind the greater trochanter. The pre- and post-operative SF12, WOMAC, Harris hip score and Pain score were assessed prospectively; blood loss, theatre time and intra-operative and post-operative complications were charted, and compared with 40 matched standard incision patients. Cup and stem component positioning was assessed radiologically. The Body Mass Index (BMI) and the incision length were charted in each patient. The post-operative time to full weightbearing and stair climbing was charted.

Results: There was no statistical difference in SF12, WOMAC, Harris hip score and Pain score in the two groups of patients. Blood loss was slightly reduced, but theatre time and intra-operative and post-operative complications were not increased. Cup and stem positioning on x-ray was not compromised. Immediate full weightbearing was allowed, including stair climbing post-operatively in all patients.

Conclusion: MIS THR via the posterior approach is a safe and reproducible procedure, for both cemented and uncemented prostheses. It requires no special instrumentation or long learning phase for the experienced hip surgeon. Blood loss, theatre time and morbidity have not been increased, allowing a rapid discharge program as a routine.