title: The mini postero-postero-lateral mini incision in total hip arthroplasty.
abstract: OBJECTIVE
  Mini invasive incisions in THA and femoral hip prostheses tend to minimise healing and recovery time. We have used a very posterior approach with technical modifications and precise skin landmarks to decrease surgical complexity, and we describe this experience here.
  
  
  METHODS
  From 2010 to 2012, 140 patients aged 79 years (range 53-93 years) were operated upon by the same surgeon in a continuous series using the same minimally invasive skin incision and six different types of implants. The incision was very posterior in the hip allowing direct visualisation of the acetabulum in the hip flexion position and visualisation of the femoral shaft extremity in a leg flexion position.
  
  
  RESULTS
  The mean operating time was 100 minutes (range 75-110 min). Estimated blood loss was 385 cc (20-585 cc). Twenty-six patients had blood transfusion. The mean hospital stay was 6.8 days (5-20 days) including the time waiting for a rehabilitation centre. No operative complications related to the technique were recorded. On the postoperative radiograph, the femoral stem was aligned with the femoral axis within 3° in all patients. The mean acetabular angle to the ground plane was 40° (35-48°). No patient had a leg length discrepancy of more than four millimetres. The mean skin incision length was seven centimetres (six to eight centimetres). All patients were seen at the clinic after six weeks and the data were unchanged at this time point.
  
  
  CONCLUSIONS
  The method and skin landmarks we describe appear to be a safe way to perform minimally invasive total hip replacement.
authors.affiliation: Department of Orthopaedics, Hôpital Saint Antoine , Paris, France, frederic.jacquot@sat.aphp.fr.
authors.forename: Frederic
authors.initials: F
authors.lastname: Jacquot
authors.forename: Mokrane
authors.initials: M
authors.lastname: Ait Mokhtar
authors.forename: Alain
authors.initials: A
authors.lastname: Sautet
authors.forename: Levon
authors.initials: L
authors.lastname: Doursounian
authors.forename: Alain-Charles
authors.initials: AC
authors.lastname: Masquelet
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Feron
mesh_terms: D000077:Acetabulum / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D005260:Female; D005269:Femur / Q000601:surgery; D006620:Hip Fractures / Q000601:surgery*; D006621:Hip Joint / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D061646:Operative Time; D015207:Osteoarthritis, Hip / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome