Modified Total Hip Replacement Procedure     We have been hearing a lot recently about hip replacement surgery that can be done through much smaller incisions than the usual twenty-five to thirty centimeter incision that most surgeons use.     The usual hip incision for a total joint replacement is either on the lateral aspect of the hip or on the posterior or buttock portion of the hip. At a meeting of the Australian Orthopaedic Association the week of October 14, 2002 a scientific article was presented in which a new hip replacement surgical procedure was described utilizing the smaller incisions.     The procedure was described by Dr. Eugene Sherry and Dr. Michael Eagan. The procedure was developed at the Sydney Private Hospital in Sydney, Australia. Dr. Sherry feels that the procedure may revolutionize the way hip replacement is currently performed.     A special instrument has been developed to cut the femoral neck, which is the initial bone cutting portion of the total hip procedure. A precise cut of the femoral neck is necessary for the total hip prosthesis to be accurately positioned.     Cutting the femoral neck divides the femoral head (ball portion of the hip joint) from the neck and then allows removal of the femoral head from the wound. Arthritis of the hip, of course, is the deterioration of the articulation between the femoral head and the socket or acetabulum as it is called.     After removal of the femoral head, preparation of the femoral canal and the hip socket, or acetabulum, is carried out.     Various instruments have apparently been developed to facilitate the procedure and to insure proper tension of the soft tissues and orientation of the prosthetic components. It is very important that orientation of the ball and socket be correct as well as having the proper soft tissue tension because these are the things which prevent the hip from dislocating.     Dr. Sherry has felt that the instruments and the small incision allow accurate placement of the components. He reported a hospital stay as little as two days.     At the Australian Orthopaedic Association's meeting where the paper was presented in Melbourne, Australia a report of forty patients undergoing the procedure was presented. Dr. Sherry estimated that the dissection would amount to approximately four percent of what the usual amount of surgery is required for a standard total hip replacement procedure. He expected to see a much-reduced incidence of soft tissue problems such as infection and deep vein thrombosis.     More accurate alignment of the prosthetic components has the advantage of potentially increasing the life span of the component parts that are inserted.     Dr. Sherry seemed confident that hip replacements in the future, and no one knows how long in the future, will be done in this way. Further study of course is required, as this seems to be a preliminary report of only forty patients.     There have been some reports in the United States of minimally invasive surgical techniques for total hip replacement procedures also.     Of course, only time will tell whether these procedures will replace the traditional total hip replacement procedure, which certainly has stood the test of time, since it was initiated in the 1960's by Dr. John Charnley in England.     More traditional types of hip replacement surgery have stood the test of time it should be stated.     The hip replacement prosthesis that we most often use in our practice is the DePuy, Inc.'s AML total hip replacement prosthesis, which has a record of ninety to ninety-five percent of the prostheses continuing to function satisfactorily after fifteen years.