M inimally invasive hip surgery techniques have been advocated as an alternative to total hip arthroplasty performed with conventional soft-tissue exposure. Purported advantages of the minimally invasive technique have included faster functional recovery, a shorter stay in the hospital, less blood loss, and an improved cosmetic result1.

Any new surgical technique involves a learning curve. The steepness of this curve and the true complication rates cannot be established until these procedures have been performed by surgeons other than those who champion the technique. Ideally, before any new procedure is adopted for widespread use, prospective, controlled, multicenter studies should prove the procedure's safety and efficacy.

Recently, three patients with catastrophic complications of minimally invasive hip replacement were referred to our tertiary total joint revision center. Each arthroplasty had been performed by a different orthopaedic surgeon who stated, in his operative note, that a minimally invasive approach had been used. Two of the patients consented to have data concerning the case submitted for publication, whereas the third patient died in the recovery room after being directly transferred from an outside clinic to our hospital. Thus, she did not sign the release form at the clinic.

C ase 1. A sixty-seven-year-old woman underwent a primary total hip arthroplasty that was performed with use of minimally invasive techniques at another institution. The patient was 5 ft and 6 in (167.6 cm) tall and weighed 180 lb (81.6 kg). The procedure was performed through a 9-cm incision. During the operation, difficulty with reaming of the acetabulum was encountered and a segmental defect in the superior dome of the acetabulum was created. The defect was recognized intraoperatively, but no suitable revision components were available and the surgeon called our institution requesting transfer of the patient to our care.