With this issue and its Supplement, The Journal for the first time
presents peer-reviewed information about the rapidly evolving modifications of
the approach to total hip arthroplasty known as minimally invasive surgery.
Are these approaches better? Do they work? Should they be generally adopted by
all orthopaedic surgeons? As of yet, we do not know the definitive answers to
these questions, and we will not know them for many years. Only with adequate
followup and use of patient-based outcomes measures in studies of large
numbers of patients will the answers be found.
We at The Journal feel a responsibility to provide the practicing
orthopaedic surgeon with contemporary knowledge about important changes in the
field. Thus, rather than wait at least ten years to have definitive answers
about these newer approaches, we are presenting some preliminary information
in context, with expert commentary, that we hope will be of use to our readers
as they try to select the best available treatment for their patients.
In February 2003, two case series involving minimally invasive hip surgery
were presented as Scientific Exhibits at the Annual Meeting of the American
Academy of Orthopaedic Surgeons in New Orleans. The Academy's Committee on
Exhibits reviewed these studies, found them to be well designed and to have
interesting short-term results, and recommended that they be published in
The Journal's Supplement. While they are preliminary studies, both
represent thoughtful analyses of the experience of skilled orthopaedic
In the Orthopaedic Forum, we are pleased to publish a symposium that was
presented at the Annual Meeting of the American Orthopaedic Association in
June of this year. Pursuing its objective to present all sides of
controversial and important topics in orthopaedics, the AOA, under the
leadership of Dr. Berry, presents the preliminary clinical experience of
selected leading orthopaedic surgeons in this field, along with well-measured
concerns expressed by other respected surgeons about the widespread and
too-rapid implementation of new techniques or technology.
Also in this issue, we present the adjoining editorial by Dr. Chitranjan
Ranawat and Dr. Amar Ranawat, who put the issue of minimally invasive surgery
in clear perspective.
It is our hope that the presentation of these preliminary clinical studies,
in a context of thoughtful criticism and concern, can provide a reasonable
foundation for all orthopaedic surgeons to use when considering if and when
the minimally invasive approach is the right step for their patients and their
While The Journal has aggressively promoted evidence-based
decision-making as the best foundation for clinical practice, clinicians
cannot be expected to wait for many years until definitive answers become
available. It is our hope that long-term studies of appropriately evaluated
patient populations treated with the new methods will be conducted to provide
these answers. However, we believe that, in the interim, the information
provided in this issue of The Journal will be of practical help to
the orthopaedist who is faced with pressing clinical questions today.