Muscle Damage During MIS Total Hip Arthroplasty: Smith-Peterson versus Posterior Approach.Meneghini, R Michael MD*; Pagnano, Mark W MD*; Trousdale, Robert T MD*; Hozack, William J MD† Section Editor(s): Hanssen, Arlen MD, Guest EditorAuthor Information From the *Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN; and †Rothman Institute of Orthopaedics, Philadelphia, PA. One or more of the authors certifies that they have or may receive payments or benefits from a commercial entity related to this work. Each author certifies that his institution has waived or does not require approval for the human protocol for this investigation and that all investigations were conducted in conformity with the ethical principles of research. Correspondence to: William Hozack, MD, Rothman Institute Orthopedics, 925 Chestnut Street, Philadelphia, PA 19107. Phone: 267-339-3622; Fax: 215-502-0580; E-mail: [email protected] Clinical Orthopaedics and Related Research (1976-2007): December 2006 - Volume 453 - Issue - pp 293-298 doi: 10.1097/01.blo.0000238859.46615.34 Buy Metrics Abstract Decreased muscle damage is a reported benefit of minimally invasive surgical (MIS) approaches in total hip arthroplasty (THA). We compared the extent and location of muscle damage during THA using the MIS anterior Smith-Peterson and MIS posterior surgical approaches. THA was performed in six human cadavers (12 hips). One hip was assigned to the Smith-Peterson approach and the contralateral hip to the posterior approach. Muscle damage was graded with a technique of visual inspection to calculate a proportion of surface area damage. Less damage occurred in the gluteus minimus muscles and minimus tendon with the Smith-Peterson approach. A mean of 8% of the minimus muscle was damaged via the Smith-Peterson approach, compared to 18% via the posterior approach. The tensor fascia latae muscle was damaged (mean of 31%), as well as direct head of the rectus femoris (mean 12%) during the Smith-Peterson approach. The piriformis or conjoined tendon was transected in 50% of the anterior approaches to mobilize the femur. The posterior approach involved intentional detachment of the piriformis and conjoined tendon and measurable damage to the abductor muscles and gluteus minimus tendon in each specimen. Clinical outcome studies and gait analysis are necessary to ascertain the functional implications of these findings. © 2006 Lippincott Williams & Wilkins, Inc.