The Minimally Invasive Total Hip replacement was developed to minimize patient morbidity and shorten recovery time. This technique is not a “small incision-large dissection” technique like some other minimally invasive techniques (commonly referred to as “mobile window” techniques). The deep dissection with this technique extends no further than the length of the incision.

This minimally invasive technique differs from the traditional total hip replacement procedure not only due to an incision 2/5 the traditional length, but also due to less deep dissection. The gluteus maximus tendon is not released. Only 4 of the 6 external rotators are detached; the piriformis and quadratus femoris tendons are left intact. The anterior and superior capsule are left intact, and the posterior capsule is retained for anatomic repair at the end of the case.

This technique can be used with cemented or cementless fixation. Dr. Swanson uses a cementless, double-wedge, tapered femoral component and a cementless acetabular component. Complications attributed at least in part to cement include pulmonary embolism, deep venous thrombosis, and even death. These complications were minimized with the use of a cementless prosthesis (1).

The double-wedge, tapered femoral component allows stable primary fixation regardless of the bone quality or shape of the proximal femur. Excellent primary fixation was obtained in Dorr A, B, and C bone types and in both “champagne flute” and “stovepipe” femurs. We had no loose femoral components in over 1000 consecutive implants. Furthermore, the incidence of thigh pain is minimal with the tapered stem, similar to that with cemented fixation (2).

The cementless, minimally invasive technique reduces complications. The incidence of dislocation, infection, nerve palsy, and loosening were comparable between the first 113 cementless, minimally invasive THA’s and the last 50 hybrid, standard incision THA’s performed by Dr. Swanson (See 2003 AAOS meeting). However, the incidence of perioperative medical complications, including cardiac, pulmonary, CNS, GI, and GU complications was significantly reduced.

The smaller incision size utilized in the minimally invasive technique results in a 50% shorter operating time than with the standard incision technique (4). There is also decreased intra-operative blood loss, and reduced need for post-operative analgesia, reduced need for post-operative oxygen supplementation, and fewer patients with mental status dysfunction. Hospitalization was 40% shorter, and time to recovery was reduced by half, from 12.9 weeks to 6.2 weeks.

Medical reference studies

Dr. Swanson's Power Point® presentation at the 2003 WOA meeting about the advantages of cementless mini-incision total hip procedure

Handout about the advantages of cementless mini-incision total hip presentation in PDF format.

Disclaimer:The information provided here is intended to educate the reader about certain medical conditions and certain possible treatment. It is not a substitute for examination, diagnosis, and medical care provided by a licensed and qualified health professional. If you believe you, your child, or someone you know, suffer from the conditions described herein, please see your health care provider immediately. Do not attempt to treat yourself, your child or anyone else without proper medical supervision.

©2008 Todd Swanson, M.D.
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The minimally invasive total hip replacement was developed by Dr. Swanson after being introduced to the concept in early 1997. Dr. Swanson began using the technique in May of 1997 and has continued to make improvements that now allow reliable surgery and reproducibly good results in most patients. Standardization of the technique has allowed teaching to other surgeons. Numerous physicians and orthopedic companies have shown interest in promoting “minimally invasive surgery” for total hip replacements.

The minimally invasive technique utilizes a 3-4 inch incision, much smaller than the 8-10 inch approach historically used for hip replacement. Patients require less anesthesia and pain medication, and mobilize more quickly. This results in both quicker recovery for the patient and a lower incidence of complications.

Patients typically recover from minimally invasive surgery in about half the time it takes to recover from standard incision surgery (6 weeks vs. 12 weeks).

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