Minimally Invasive Total Hip Replacement

Total hip replacement (also known as total hip arthroplasty) is a common orthopedic procedure and, as the population ages, it is expected to become even more common. Replacing the hip joint with an implant, or prosthesis, relieves pain and improves mobility, enabling you to resume your normal, everyday activities.

The traditional surgical approach to total hip replacement uses a relatively long incision, with extensive soft tissue exposure, to view and access the hip joint. A variation of this approach is a minimally invasive procedure in which the surgeon uses one or more shorter incisions, or changes the location of the incision.

The goal of using shorter incisions or changing the location of the incision is to reduce pain and speed recovery. Minimally invasive techniques may not, however, be suitable for all patients. Your orthopedic surgeon will discuss different surgical options with you.

Description

During any total hip replacement surgery, the damaged bone is cut and removed, along with release of some soft tissues surrounding the joint. In minimally invasive surgery, the surgeon makes a smaller surgical incision and cuts or detaches fewer muscles around the hip.

Despite this difference, however, both traditional total hip replacement surgery and minimally invasive surgery are technically demanding and have better outcomes if the surgeon and operating team have a lot of experience.

Traditional Total Hip Replacement

To perform a traditional total hip replacement:

  • The surgeon makes a 10- to 12-inch incision on the side of the hip, then splits or detaches the muscles from the hip, allowing the hip to be dislocated and fully viewed.
  • The surgeon removes the damaged femoral head and inserts a metal stem into the hollow center of the femur. The surgeon then places a metal or ceramic ball on the upper part of the stem. This ball replaces the damaged femoral head that was removed.
  • The surgeon removes the damaged cartilage surface of the socket (acetabulum) and replaces it with a metal socket. The surgeon may use screws or cement to hold the socket in place.
  • The surgeon inserts a plastic, ceramic, or metal spacer between the new ball and the socket to allow for a smooth gliding surface.

(Left) The individual components of a total hip replacement. (Center) The components merged into an implant. (Right) The implant as it fits into the hip.

Minimally Invasive Total Hip Replacement

The goals are similar with minimally invasive total hip replacement, but the surgeon cuts less of the tissue surrounding the hip. The artificial implants used are the same as those used for traditional hip replacement. However, specially designed surgical instruments are needed to prepare the socket and femur and to place the implants properly.

Minimally invasive total hip replacement can be performed with either one or two small incisions. Smaller incisions allow for less soft tissue disturbance.

Minimally invasive surgery based on a small incision or multiple incisions

Small-incision surgery using the posterior, lateral, or anterolateral approach

  • For this type of minimally invasive total hip replacement, the surgeon uses a single incision that usually measures 3 to 6 inches. The length of the incision depends on the size of the patient and the difficulty of the procedure.
  • The surgeon makes the incision on the side or back of the hip. The muscles and tendons are split or detached from the hip, but to a lesser extent than in traditional total hip replacement surgery. They are routinely repaired after the surgeon places the implants. This encourages healing and helps prevent dislocation of the hip.

Multiple-incision surgery

  • Some surgeons perform a hip replacement through two separate small incisions. The concept behind two incisions is to approach the pelvis (cup) through one incision and the femur (thighbone) through a separate incision.
  • Approaching the hip in this manner may allow for less disruption of the underlying tissues compared to using one incision.
  • For this procedure, surgeons often use X-ray guidance during surgery to ensure proper placement of the implants.

Minimally invasive surgery based on incision location

Direct anterior approach

Another approach to minimally invasive surgery is to change the location of the incision. The direct anterior approach has become popular because it requires less disruption of the underlying tissue and muscle.

  • In this approach, the surgeon makes the incision on the front of the hip.
  • Less cutting of the muscle is necessary, and recovery has been reported to be faster.
  • The anterior approach is often performed with the use of a special operative table and instruments.

As with traditional hip replacement surgery, after minimally invasive hip replacement, you will either go home the same day or spend 1 to 3 days in the hospital.

Physical rehabilitation is a critical component of recovery. Your surgeon or a physical therapist will provide you with specific exercises to help increase your range of motion and restore your strength.

Candidates for Minimally Invasive Total Hip Replacement

Minimally invasive total hip replacement is not suitable for all patients. Your doctor will conduct a comprehensive evaluation and consider several factors before determining whether the procedure is an option for you.

In general, candidates for minimal incision procedures are thinner, younger, healthier, and more motivated to participate in the rehabilitation process than patients who undergo the traditional surgery.

Minimally invasive techniques may be less suitable or create a higher risk of complications for patients who:

  • Are overweight
  • Have already undergone other hip surgeries
  • Have a significant deformity of the hip joint
  • Are very muscular
  • Have health problems that may slow wound healing

Conclusion

Minimally invasive and small incision total hip replacement surgery is an evolving area. Surgeons continue to refine the techniques and instrumentation to improve recovery after surgery. Special training is needed for these approaches, and more research is needed on the long-term results.

The benefits of minimally invasive total hip replacement have been reported to include less damage to soft tissues, leading to a quicker, less painful recovery and more rapid return to normal activities. Current evidence suggests that the long-term benefits of minimally invasive surgery do not differ from those of traditional total hip replacement.

Like all surgery, minimally invasive surgery has a risk of complications. These complications include:

Like traditional total hip replacement surgery, minimally invasive total hip replacement should be performed by a well-trained, highly experienced orthopedic surgeon. Your orthopedic surgeon can talk to you about their experience with minimally invasive hip replacement surgery, and the possible risks and benefits of the techniques for your individual treatment.

Source:  AAOS

Golden State Orthopedics & Spine (GSOS) takes a multi-faceted approach to treating hip pain and injuries, beginning with the least invasive and simplest solutions. We start with conservative treatments such as medication and lifestyle changes. We will also look at alternative treatments including physical therapy and different types of injections such as cortisone.

Hip Replacement & Hip Replacement Revision

At GSOS we offer a range of hip replacement surgeries, as well as hip replacement revision surgeries that correct problems with a previous hip replacement. Each patient will meet with an orthopedic surgeon and go over the differences in the treatment options and find the best solution for them. Below is a very brief overview, and it is best to discuss your case with one of our surgeons.

  • Total hip replacement, also known as total hip arthroplasty, is completed through an incision on the side of the hip that is between 10- to 12-inches. The muscles are detached or split from the hip. This allows the surgical team to fully view and dislocate the hip. The damaged bone or cartilage will be removed and replaced with prosthetic components commonly made of metal, plastic or ceramic materials.
  • Minimally invasive total hip replacement surgery is similar to the total hip replacement process but there is less cutting of the tissue surrounding the hip. The surgery can be performed with one or two smaller incisions.
  • Anterior minimally invasive hip replacement surgery involves an incision through the front of the hip allowing the surgeon to reach the joint by separating rather than cutting and reattaching muscles. This allows for more aggressive rehabilitation after surgery.
  • Computer navigation hip replacement is available at GSOS. A computer navigation hip replacement is not completed by a robot but rather a computer that provides the surgeon with accurate information that assists in the surgery. This technology has reduced implantation-related complications by improving the placement, ligament balance, and leg length.
  • Failed hip replacement revision is a surgery to revise previous hip replacement. A hip replacement can fail for a number of reasons, including wearing out over time, infection, fractures, etc. The revision surgery can take many forms, such as revising only some elements of the artificial hip, removal and replacement of the whole prosthetic hip, and complete removal along with rebuilding segments of the bone with materials or a bone graft.

Birmingham Hip Resurfacing

Birmingham hip resurfacing (BHR) is an approach that resurfaces just a few centimeters of the joint with minimal bone loss. This treatment uses metal bearings to preserve, rather than replace, a patient’s femoral head and neck (top of the thigh bone) in the hip. The ideal candidate for BHR is usually an active adult under 60 years old in need of a hip replacement, but be sure to confirm this with an orthopedic specialist.

Hip Arthroscopy

Hip arthroscopy is a minimally invasive hip surgery in which an orthopedic surgeon views the hip joint by inserting a small camera, called an arthroscope, into the joint. This allows the doctor to see around inside the joint without making a large incision.

Hip arthroscopy can be used as an exploratory surgery to diagnose the cause of hip pain or used to treat a hip condition. Some of the conditions include labral tears, femoroacetabular impingement and the removal of loose fragments of cartilage inside the joint.

The small incision of used in arthroscopy has many advantages including less pain, a shorter recovery time, less scarring and less joint stiffness.

Fracture Treatment & Repair

When a patient fractures his or her hip there are multiple different treatment options depending on where the fracture is and the patient’s current health. Treatment for a hip fracture should be done as close to the time of the injury as possible. We will find the best option for any patient coming in with a hip fracture.