Minimally-Invasive Total Hip Replacement Surgery
Last updated Friday, August 10, 2007
Considering surgeryWhat kinds of surgery are recommended for minimally-invasive total hip replacement surgery - degenerative joint disease? Hip replacement surgery should be considered when other,
non-surgical, methods of treating hip arthritis have been attempted without
success.
There are two surgical approaches - traditional hip replacement and minimally - invasive hip replacement surgery.
Traditional hip replacement surgery requires a large
incision over the hip bone and the separation of muscle from the joint. By
contrast, surgeons using the newer minimally-invasive technique make two
smaller incisions – a 2 inch one in front of the hip and a 1.5 inch one in back
(though incision length can vary with the size of the patient). Using x-ray
guidance and special tools, the surgeon pushes aside muscle instead of cutting
through it. The socket portion of the hip joint is replaced through the front
incision and the ball portion of the hip joint (on top of the thigh bone)
through the back incision. Who should consider Minimally-Invasive Total Hip Replacement Surgery? About two-thirds of patients who undergo hip replacement are
eligible for the minimally-invasive approach. Candidates include:
- People who are fit and motivated enough to handle the accelerated rehabilitation process
- Those who have adequate social support at home to assist them
immediately following surgery. Minimally-invasive surgery patients
return home after only two days in the hospital and will require
assistance around the house for at least one to two weeks
- People who do not have other significant medical problems, and
those whose medical issues (e.g. diabetes or high blood pressure)are
well managed
Patients, who are obese, have severe osteoporosis (low bone
density) or who have had previous hip surgery generally need to undergo the
traditional hip replacement operation. What happens if nothing is done for minimally-invasive total hip replacement surgery - degenerative joint disease (best case/worst case scenarios)? If nothing is done to treat hip osteoarthritis/degenerative
joint disease, it is not life threatening. But frequently the pain, discomfort,
swelling, etc. of the condition can significantly reduce one’s quality of life.
This can be seen in an increasing inability to be active. Getting good quality
sleep may also become increasingly difficult, thus inhibiting one’s ability to
perform activities of daily life.What options exist for surgery for minimally-invasive total hip replacement surgery - degenerative joint disease? There are two approaches available for total hip replacement
surgery. Which approach to use depends upon the patient’s specific condition, a
number of medical issues, and the surgeon’s comfort with each of the various
available options.
Other surgical options include:
Hip resurfacing
surgery – Surface replacement initially was introduced in the 1970s.
However, durability was poor and most surgeons abandoned the procedure. There
has been a resurgence of interest in surface placement over the past decade
because of improvements in design, bearing surface, and instrumentation.
The potential advantages of resurfacing include:
preservation of femoral bone use of a bigger femoral head component, which may
be more stable; also, it has been theorized that subsequent revisions may be
easier.
However, disadvantages include the inability to adjust for
leg length differences, and a relatively high risk of femoral neck fracture.
Also, there are concerns about disruption of blood supply to femoral head with
this operation. Potential risks such including metal allergies and systemic
effects (corrosion products from metals going to other organs) have been raised
as concerns with this approach. Patients potentially eligible for hip
resurfacing are younger, active patients (<60), with good bone stock, who
understand that the risks may be greater and that less is known about the long-term
results with this approach than with total hip replacement.
Hip arthroscopic
surgery – Hip arthroscopy allows evaluation of hip pain in patients with
nonspecific x-ray and MRI findings and reproducible, functionally-limiting
physical signs and symptoms. It can also be used for treatment of
synovitis (where the hip capsule lining becomes inflamed), removal of loose
bodies, and treatment of labral tears. It is not effective for treating
osteoarthritis for most patients. When performed by an experienced surgeon, how effective is hip osteoarthritis for minimally-invasive total hip replacement surgery - degenerative joint disease likely to be and how long will the benefit last? Both traditional and minimally-invasive hip replacement
surgeries use the same implants. In research studies, it has been found that
for most patients, the likelihood that the implant will still be functioning
well 10 years after the operation is about 90 percent; fewer data are available
at 20 years, but some studies suggest that the likelihood the implant will
still be in service after two decades is between 75 and 80 percent.How urgent is hip osteoarthritis for minimally-invasive total hip replacement surgery - degenerative joint disease? Hip replacement surgery is rarely urgent. It is an elective
procedure performed when the patient decides the pain and discomfort is such
that he or she no longer wishes to endure it. Also to be considered is whether
the hip arthritis is preventing him/her from participating in desired
activities and performing the activities of daily life.What are the most frequent and most serious risks of hip osteoarthritis for minimally-invasive total hip replacement surgery - degenerative joint disease? How common are they? The possible risks involved in hip replacement surgery
include:
- Infection in the soft tissue or bone of the hip
- Limb-length difference requiring use of a shoe lift
- Nerve injury or vascular damage
- Blood clot
- Restricted movement or stiffness of the hip joint
- Need for a blood transfusion
- Dislocation of the hip or fracture of the bone during surgery
For most patients, the likelihood of having a major
complication – defined as a complication that could leave the patient worse off
after the procedure than (s)he was before it – is extremely low. If risks occur during or after hip osteoarthritis for minimally-invasive total hip replacement surgery - degenerative joint disease how are they managed? Following hip replacement surgery:
- If an infection occurs around the implant, this
frequently requires further surgery.
- With nerve damage, physical therapy may be prescribed to provide
desensitization. Sometimes medications are used to manage nerve pain,
should this be necessary.
- With restricted movement or stiffness, physical therapy may be
prescribed to help mobilize the joint. Very rarely (a small fraction of
one percent of the time), surgery can be used to help patients with
severe stiffness.
- If bleeding occurs, blood transfusions are
sometimes given; some patients elect to pre-donate their own blood in advance
of surgery.
- If a blood clot occurs, blood thinners may be prescribed, along
with use of special stockings, leg pumps. Hip dislocations are treated
by manually repositioning the ball into the socket. If the dislocation
recurs, surgery may need to be performed again.
The best way to treat complications is to avoid them;
specific precautions are taken to try to avoid all of the above complications,
as well as others that might occur. Surgery for Minimally-Invasive Total Hip Replacement Surgery - degenerative joint disease at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4288 (outside the Seattle area: 800-440-3280) to make an appointment.
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