The objective is for the patient to end up with a stable, comfortable hip that lasts a long time. Whatever the choice of surgical procedure, it should serve that purpose.
Everything is minimizing these days. There is minimally invasive knee surgery, spinal surgery, and heart surgery. We are all minimalists, at heart. Our goal is to minimize the time and trauma imposed on our patients. However, when it comes to hip replacement, minimal is not always the best option. A lot depends on the patient’s condition. While minimal in this case means a smaller incision and hopefully less damage to muscles and tendons, it can work against the longterm results. As always in orthopedics, a thorough presurgical exam and diagnosis is the place to begin.
For starters, the hip is a major joint and involves a large area. With total hip replacement, the surgeon removes the top of the femur, or thigh bone, and replaces it with an artificial stem and ball. Then a man-made cup is inserted into the hip socket.
Minimally invasive techniques fall into two categories. One involves a single incision of five inches or less (compared with the standard eight to ten inches). The second category is called a two-incision procedure. In this case, the surgeon performs the operation through two incisions, each less than two inches long.
Try to imagine you are removing the gizzards from your Thanksgiving turkey. The turkey is still raw when you make two small cuts in his back. Then you insert a knife in each one and you attempt to locate, incise and remove the gizzards without doing too much damage to the rest of the bird. OK, we exaggerate. But minimal does not mean easy.
One orthopedic doc puts it succinctly: The goal is a pain-free, stable hip that won’t need to be replaced,’ he says. To that end, the main concern is to find a trusted surgeon and a clinic that doesn’t drop the ball until the patient is satisfied.
Pros and Cons From the Pros
The jury is still out on whether minimally invasive surgery will overtake conventional as the preferred treatment. According to a study of 80 patients who had minimally invasive hip replacement (arthroplasty) performed by an experienced surgeon, the rate of complications was four times higher than with traditional methods, and the complications were more serious. (This study was presented at a meeting of the American Academy of Orthopaedic Surgeons.)
Generally, some types of patients are more apt to benefit from minimally invasive arthroplasty, including:
- younger patients
- patients who are thinner
- those who are willing to fully engage in the rehab process
- healthier patients, with no prior hip surgeries
- patients without a great deal of muscle
- those without a hip deformity
Higher Risk of Complications
Supporters maintain that minimally invasive surgery results in less damage to soft tissues, less bleeding, and less time on the operating table. But the record doesn’t show any difference in longterm outcomes.
All surgery involves some risk, of course. Possible complications include injuries to nerves and arteries, infection, fracture of the femur, and errors in positioning the hip implant. Afterward, there is concern about the wound healing, which is why fundamentally unhealthy patients are sometimes discouraged from considering hip replacements.
Let Your Surgeon Be Your Guide
Every orthopedic organization sounds the same mantra: The most important factor in surgical success in the surgeon. You need a surgeon you can trust, someone with whom you have a good rapport. The surgeon should specialize in the type of surgery you are contemplating. He or she should have a clinical staff to support every aspect of the process— from diagnostics to rehab.
If you find a good surgeon, you can then consider your own condition and discuss whether minimally invasive hip replacement is the right choice for you. At this point in time, there’s no fixed answer.