There are several techniques that may be employed during a hip replacement surgery. These are usually named according to where the incision is made in relation to the gluteus medius muscle.
These surgical techniques include the following:
- Posterior approach (Moore’s technique)
- Lateral approach (Hardinge or Liverpool technique)
- Antero-lateral approach (Watson-Jones technique)
- Anterior approach (Smith-Petersen technique)
- Greater trochanter osteotomy
None of these technique has ever been shown to be significantly superior to any if the others. However, general expert opinion seems to favor either the antero-lateral technique or the posterior technique.
For the posterior (Moore’s) technique, the joint and capsule are approached via the back and the piriformis muscle and short ecternal rotators are removed from the femur. In this way, good access to the acetabulum and femur is allowed while the hip abductors are preserved, to minimize the risk of abductor dysfunction following the surgery.
Some research suggests an increased risk of joint dislocation with this approach, although this risk can be reduced through repair of the piriformis, capsule and short external rotators, combined with the use of a large femoral head.
For the lateral approach, hip abductors such as the gluteus medius and gluteus minimus are elevated to access the joint. The lifting of these abductors may be achieved through osteotomy of the greater trachenter and its reapplication via wires afterwards or through division of the abductors at their tendinous portion, which can then be repaired through surgical suture.
For the anterolateral approach, access is created between the tensor fasciae latae and the gluteus medius, while for the anterior approach the gap is made between the sartorius muscle and tensor fascia latae.
The minimally invasive approach to hip replacement aims to reduce soft tissue damage by reducing the size of the incision. However, this significantly impairs the accuracy of component positioning during surgery as well as significantly limiting visualization of the bone structures.