1. Percutaneously Assisted Total Hip Arthroplasty (PATH): A Preliminary Report by Brad L. Penenberg, W. Seth Bolling, and Michelle Riley J Bone Joint Surg Am Volume 90(Supplement 4):209-220 November 1, 2008 ©2008 by The Journal of Bone and Joint Surgery, Inc.

2. The center of rotation is derived from the acetabular location (not shown). Brad L. Penenberg et al. J Bone Joint Surg Am 2008;90:209-220 ©2008 by The Journal of Bone and Joint Surgery, Inc.

3. To allow maximum limb adduction, the patient is positioned as far forward on the peg board as possible. Brad L. Penenberg et al. J Bone Joint Surg Am 2008;90:209-220 ©2008 by The Journal of Bone and Joint Surgery, Inc.

4. The incision begins at the posterior corner of the greater trochanter. Brad L. Penenberg et al. J Bone Joint Surg Am 2008;90:209-220 ©2008 by The Journal of Bone and Joint Surgery, Inc.

5. The piriformis tendon is identified and then released as close to its insertion as possible. Brad L. Penenberg et al. J Bone Joint Surg Am 2008;90:209-220 ©2008 by The Journal of Bone and Joint Surgery, Inc.

6. The capsular incision extends posterior to the acetabular rim for 8 to 10 mm. Brad L. Penenberg et al. J Bone Joint Surg Am 2008;90:209-220 ©2008 by The Journal of Bone and Joint Surgery, Inc.

7. The anterior acetabular retractor is placed inferiorly and the Hohmann retractor is placed superiorly in relation to the femoral neck to visualize resection level and protect the soft tissues. Brad L. Penenberg et al. J Bone Joint Surg Am 2008;90:209-220 ©2008 by The Journal of Bone and Joint Surgery, Inc.

8. Photograph showing the anterior acetabular retractor, a 1/8-in (3.2-mm) Steinmann pin placed superiorly between the capsule and labrum at the twelve o'clock position, (i.e., directly toward the head of the patient in the thick supra-acetabular bone) and a d... Brad L. Penenberg et al. J Bone Joint Surg Am 2008;90:209-220 ©2008 by The Journal of Bone and Joint Surgery, Inc.

9. Acetabular visualization with the retractors in place. Brad L. Penenberg et al. J Bone Joint Surg Am 2008;90:209-220 ©2008 by The Journal of Bone and Joint Surgery, Inc.

10. Brad L. Penenberg et al. J Bone Joint Surg Am 2008;90:209-220 ©2008 by The Journal of Bone and Joint Surgery, Inc.

11. Brad L. Penenberg et al. J Bone Joint Surg Am 2008;90:209-220 ©2008 by The Journal of Bone and Joint Surgery, Inc.

12. The portal placement guide, trocar, and cannula in place. Brad L. Penenberg et al. J Bone Joint Surg Am 2008;90:209-220 ©2008 by The Journal of Bone and Joint Surgery, Inc.

13. Reamer basket insertion (top left corner) with the reamer driver inserted through the cannula posterior to the femur with full acetabular visualization. Brad L. Penenberg et al. J Bone Joint Surg Am 2008;90:209-220 ©2008 by The Journal of Bone and Joint Surgery, Inc.

14. The acetabular component is introduced in line with the incision (left). Brad L. Penenberg et al. J Bone Joint Surg Am 2008;90:209-220 ©2008 by The Journal of Bone and Joint Surgery, Inc.

15. Retraction is accomplished with an offset Hohmann retractor placed over the greater trochanter superiorly and a calcar retractor along the medial portion of the calcar, beneath the short external rotators. Brad L. Penenberg et al. J Bone Joint Surg Am 2008;90:209-220 ©2008 by The Journal of Bone and Joint Surgery, Inc.

16. The saddle area (S) and piriformis fossa are cleared of soft tissue, and the arcuate chisel is used to safely open the lateral portion of the calcar and extend the opening to the inner or medial cortex of the greater trochanter. Brad L. Penenberg et al. J Bone Joint Surg Am 2008;90:209-220 ©2008 by The Journal of Bone and Joint Surgery, Inc.

17. A T-handle reamer with a tissue protector sleeve is used to identify the canal axis and lateralize an entry hole into the proximal part of the femur. Brad L. Penenberg et al. J Bone Joint Surg Am 2008;90:209-220 ©2008 by The Journal of Bone and Joint Surgery, Inc.

18. Broaching is performed with in-line calibrated broach handles. Brad L. Penenberg et al. J Bone Joint Surg Am 2008;90:209-220 ©2008 by The Journal of Bone and Joint Surgery, Inc.

19. Brad L. Penenberg et al. J Bone Joint Surg Am 2008;90:209-220 ©2008 by The Journal of Bone and Joint Surgery, Inc.

20. Brad L. Penenberg et al. J Bone Joint Surg Am 2008;90:209-220 ©2008 by The Journal of Bone and Joint Surgery, Inc.

21. The peg board, with radiolucent pegs, permits intraoperative radiographic assessment of limb length and femoral and acetabular component apposition and alignment as well as offset. Brad L. Penenberg et al. J Bone Joint Surg Am 2008;90:209-220 ©2008 by The Journal of Bone and Joint Surgery, Inc.

22. Modular neck and femoral component insertion. Brad L. Penenberg et al. J Bone Joint Surg Am 2008;90:209-220 ©2008 by The Journal of Bone and Joint Surgery, Inc.