The anterior approach to hip arthroplasty: the short, single minimally invasive incision

A modified anterior approach to the hip developed by the senior author has been utilized in performing over 7,000 hip replacement operations in the past three decades. It can be readily applied to both primary and revision surgery, and involves muscle splitting and sparing of the major hip muscles, their innervation, and their function. Since the late 1970s, Yale orthopaedic residents have been taught this minimally invasive anterior approach using 1, 2, or 3 mini-incisions without fluoroscopy, special operating room tables, or special retractors. Our overall experience has documented a very low incidence of dislocation and minimal perioperative complications. While a smaller skin incision is desirable for cosmetic reasons and decreased healing time, what goes on beneath the skin is far more important. A well-placed total hip replacement should never be compromised. While many of our patients can ambulate the same or first postoperative day quite well, we do not advocate outpatient total hip arthroplasty. Bone is still cut, tissues bleed, clots can form, and the traditional complications of arthroplasty, while reduced, can still occur.