The total hip arthroplasty (THA) is an orthopedic procedure that is performed 280 000 times annually in the United States of America (Cram et al., 2012). THA is one of the most common surgical procedures performed in the US and worldwide (Lohmander et al., 2006). The presence of severe and continuing pain and disability and the inability to perform one’s job or participate in social and leisure activities generally make the decision to undergo the surgery easier for the patient and surgeon. THA is generally considered a safe procedure with major complication rates of approximately 3% for a primary procedure and 8% for revision procedures (Khatod et al., 2008). Overall, because of an aging society, it is anticipated an increasing number of elderly people will be undergoing total joint arthroplasty (Reininga et al., 2012).

The primary indications for a total hip replacement are:

There are relatively few contraindications to the THA procedure other than active local or systemic infection and other medical conditions (e.g. diabetes mellitus, peripheral vascular disease) that increase the risk of perioperative complications or death (Barrett et al., 2005). Hemiarthroplasty, or partial reconstruction of the hip, is performed when the acetabular cartilage is intact and joint pathology is limited to the femoral side of the joint (Dalury, 2005).

Previously, obesity had been considered a contraindication to surgery because of a reported high mechanical failure rate in heavier patients. The prospect of long-term reduction in pain and disability for heavier patients may, however, offset the risk associated with potential mechanical failure (Phillips et al., 2003).

Data indicate that 62% of all THA procedures performed in the US are performed in women, with two-thirds of those procedures being performed in persons older than 65 years of age. The highest age-specific rate of THA in men is between the ages of 65 and 74 years. For women, the highest age-specific rate is between 75 and 84 years.

If the patient desires to undergo bilateral hip replacement sequentially, it is recommended that he or she wait at least 6 weeks between operations to avoid increased risk of complications from the presence of an occult venous thrombus from the first procedure. Otherwise, the bilateral procedure poses no increase in frequency of postoperative complications.

Historically, aseptic loosening of implanted components was identified as a major problem with THA. This problem was especially prevalent in younger and more active patients and in those who had undergone revision surgery. In the past two decades, however, the number of complications involving mechanical loosening has declined significantly. The incidence of mechanical loosening has decreased, as a result of improved fixation techniques, to the point where more than 90% of all total joints are never revised.

The primary surgical approaches used for THA are the anterolateral and the posterior approaches. The choice of surgical approach often depends upon the surgical training of the physician. Many of the difficulties associated with using the anterolateral approach are related to the anterior third of the gluteus medius muscle, which partially obstructs the insertion of the stem of the component into the femur. This has become a more critical element with the introduction of cementless technology. The anterolateral approach does, however, provide excellent exposure of the acetabulum, which is why some surgeons prefer that approach. Additionally, some data indicate patients receiving the anterior approach for THA tend to recover more quickly and have improved early outcomes, with dislocation rates at less than 1% (Moskal et al., 2013).

Regardless of the approach taken, difficulties are occasionally encountered. When using the posterior approach, there is a tendency to place the femoral component in less than normal anteversion, thereby leading to less postoperative external rotation because of the presence of an intact anterior capsule. A patient who undergoes the anterolateral approach commonly demonstrates less internal rotation postoperatively and a weaker hip abductor that is associated with surgical interference with the function of the abductor muscle.

There have been reports about the effectiveness of the minimally invasive approach to THA. The minimally invasive approach for hip arthroplasty was designed to transect less muscle and tendon. Therefore, it was expected to reduce hospital length of stay, pain levels, promote a quicker recovery and yield an improved cosmetic appearance (Berger, 2004). Total blood loss utilizing the minimally invasive procedure has been determined to be less than with conventional arthroplasty (Higuchi et al., 2003). Studies indicate the use of this procedure has not been found to increase the rate of postoperative dislocation (Siguier et al., 2004).