Minimally invasive hip surgery.

Describe the most common techniques used for minimally invasive hip surgery. Certainly the most commonly described approaches in the literature are the posterior and direct anterior. The posterior approach is essentially the same as what surgeons have done traditionally but with a shorter incision and less dissection of the deep musculature. The 2-incision approach, which I prefer, has fallen out of favor because it is technically diffi cult; several proponents of the 2-incision approach have switched to using an anterior approach only and then placing the femur into hyperextension and external rotation. The basic issue with hip replacement is that you have 2 different axes—that of the acetabulum and that of the femur. To access these axes, you have 3 options: (1) make an incision long enough to incorporate both axes in 1 incision (a traditional approach); (2) make a short incision and move the axis into the incision, which is what we do with an anterior approach—the femur is drawn into the wound; or (3) make a dissection in line with the acetabulum and a second dissection in line with the femur (the 2-incision approach). Overall, the concept is of hip replacement as a soft tissue procedure with the parenthetical inclusion of implant placement.