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Editorials   |    
Minimally Invasive Surgery
James D. Heckman, MD
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The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2003 Nov 01;85(11):2069-2069
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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 surgeons.
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 practice.
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.

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Accreditation Statement
These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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