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Letters to the Editor  |   June 2010
Total Hip Arthroplasty: Comparison of Two-Incision and Standard Techniques
Author Affiliations
  • Jonathon M. Brown, OMS III
    Touro University Nevada College of Osteopathic Medicine, Henderson
Article Information
Neuromusculoskeletal Disorders
Letters to the Editor   |   June 2010
Total Hip Arthroplasty: Comparison of Two-Incision and Standard Techniques
The Journal of the American Osteopathic Association, June 2010, Vol. 110, 322. doi:10.7556/jaoa.2010.110.6.322
The Journal of the American Osteopathic Association, June 2010, Vol. 110, 322. doi:10.7556/jaoa.2010.110.6.322
To the Editor:  
I read with great interest the January original contribution by Dana R. Desser, DO, and colleagues1 comparing the two-incision and standard techniques for performing total hip arthroplasty (THA). It is encouraging to see original research articles on such important topics published in the premier journal of the osteopathic medical profession. 
Although Desser et al1 are quick to point out the advantages of the two-incision technique, they are careful to also discuss the increased rate of complications associated with this technique in their small study. Complications from the two-incision approach—such as increased operative time, increased incidence of femoral fracture, and increased incidence of femoral nerve palsy—have been well discussed in the orthopedic literature.2,3 
In addition to describing their own experiences and difficulties with the two-incision approach to THA, Desser et al1 make a valid point regarding the expansion of interest among patients and physicians in minimally invasive surgical (MIS) techniques. The authors1 note that patients are inquiring about MIS techniques more often as a result of aggressive direct-to-patient marketing on television and the Internet. This issue has generated concern in the orthopedic medicine community.4,5 It should be of equal concern to the cadre of osteopathic primary care physicians who are on the “front lines” interacting with patients who have chronic orthopedic conditions, such as osteoarthritis. 
Considering the increased complication rate and the steep learning curve associated with MIS techniques, specifically the two-incision THA technique,1-5 osteopathic physicians should find it disconcerting that such techniques are being marketed to patients so brazenly. The two-incision MIS approach has been characterized as “more hype than hope” in a presentation to the American Academy of Orthopaedic Surgeons.6 As such, this surgical approach should be cautiously and fairly discussed with patients. 
I hope to accomplish two goals through the present letter. First, I would like to encourage the American Osteopathic Association to continue its support of scholarly work similar to that of Desser et al1 in all facets of osteopathic medicine. Second, I implore all osteopathic physicians—especially those in primary care disciplines—to take a second look at the article by Desser et al1 and to perhaps conduct their own studies on this matter. We need to be aware of the various aspects behind MIS techniques, because this could be a topic of interest to many of our patients. 
Desser DR, Mitrick MF, Ulrich SD, Delanois RE, Mont MA. Total hip arthroplasty: comparison of two-incision and standard techniques at an AOA-accredited community hospital. J Am Osteopath Assoc. 2010;110(1):12-15. Available at: http://www.jaoa.org/cgi/reprint/110/1/12. Accessed June 14, 2010.
Pagnano MW, Leone J, Lewallen DG, Hanssen AD. Two-incision THA had modest outcomes and substantial complications. Clin Orthop Relat Res. 2005;441:86-91.
Bal BS, Haltom D, Aleto T, Barrett M. Early complications of primary total hip replacement performed with a two-incision minimally invasive technique. J Bone Joint Surg Am. 2005;87(11):2432-2438.
Ranawat CS, Ranawat AS. Minimally invasive total joint arthroplasty: where are we going? J Bone Joint Surg Am. 2003;85-A(11):2070-2071.
Berry DJ, Berger RA, Callaghan JJ, Dorr LD, Duwelius PJ, Hartzband MA, et al. Minimally invasive total hip arthroplasty. Development, early results, and a critical analysis. Presented at the Annual Meeting of the American Orthopaedic Association, Charleston, South Carolina, USA, June 14, 2003. J Bone Joint Surg Am. 2003;85-A(11):2235-2246.
Swanson TV. Two-incision technique more hype than hope—affirms. Paper presented at: American Academy of Orthopaedic Surgeons MIS Meeting; September 2004; Chicago, IL.