Technique of Tissue-preserving, Minimally-invasive Total Hip Arthroplasty Using a Superior Capsulotomy

Preservation of the tissues surrounding the hip may improve hip joint stability and facilitate recovery. A new technique for performing total hip arthroplasty with a superior capsulotomy allows for maximal preservation of the hip joint capsule and surrounding muscles. Using this technique, the gluteus medius and minimus are reflected anteriorly and the piriformis is reflected posteriorly. The short external rotators and posterior capsule are left intact. In most cases, the femur is instrumented with straight instruments before the femoral head is excised. This provides additional strength and stability to the femur during preparation. The femoral head is excised, rather than dislocated, to minimize disruption of surrounding tissues. The acetabulum is prepared and the acetabular component is inserted with angled instruments. This allows the femur to remain in physiologic positions throughout the procedure. Experience with this procedure demonstrates that, while technically demanding, the patients return to a normal gait more rapidly, with unrestricted motion and weight bearing postoperatively. The procedure offers the opportunity to facilitate recovery while potentially decreasing both shortand long-term surgical complication rates compared with conventional total hip arthroplasty techniques.