Minimally Invasive Hip Surgical Procedure
In minimally invasive total hip replacement, the surgical procedure is similar, but there is less cutting 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 tissue disturbance.
Single-incision surgery. In this type of minimally invasive hip replacement, the surgeon makes a single incision that usually measures from 3 to 6 inches. The length of the incision depends on the size of the patient and the difficulty of the procedure.
The incision is usually placed over the outside of the hip. The muscles and tendons are split or detached from the hip, but to a lesser extent than in traditional hip replacement surgery. They are routinely repaired after the surgeon places the implants. This encourages healing and helps prevent dislocation of the hip.
Two-incision surgery. In this type of minimally invasive hip replacement, the surgeon makes two small incisions:
- A 2- to 3-inch incision over the groin for placement of the socket, and
- A 1- to 2-inch incision over the buttock for placement of the femoral stem.
To perform the two-incision procedure, the surgeon may need guidance from x-rays. It may take longer to perform the two-incision surgery than it does to perform traditional hip replacement surgery.
The hospital stay after minimally invasive surgery is similar in length to the stay after traditional hip replacement surgery–ranging from 1 to 4 days.
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.
Patient Selection Criteria
Minimally invasive total hip replacement is not suitable for all patients. Your Wisconsin Bone & Joint doctor will conduct a comprehensive evaluation and consider several factors before determining if 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, compared with patients who undergo the traditional surgery.
Minimally invasive techniques are less suitable for patients who are overweight or who have already undergone other hip surgeries. In addition, patients who have a significant deformity of the hip joint, those who are very muscular, and those with health problems that may slow wound healing may be at a higher risk for problems from minimally invasive total hip replacement.
The reported advantages of less invasive surgery occur in the first few weeks or months after surgery. The reported short-term advantages include:
- Smaller incision length (improved cosmesis)
- Less discomfort (immediate peri-operative pain)
- Less blood loss (fewer blood transfusions)
- Shorter hospitalization
- Shorter rehabilitation
- Earlier return to work
- Potential Complications
The reported disadvantages of less invasive surgery relate to the difficulty of performing surgery within a restricted visual field as well as issues related to learning a new exposure technique.
The reported disadvantages include:
- Stretching/tearing of skin/soft tissues
- A more restricted visual surgical field
- Increased duration of surgery
- Superficial nerve injury in hip surgery with the anterior incision
- Fracture of bone during implant insertion
- Limited implant choices