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Is Less-Invasive Hip Replacement Best for You?

Finding the right surgeon and asking the right questions can help determine if minimally invasive hip replacement is right for you.

Wanted: Better Evidence

Experts say there is simply not enough scientific evidence about this new form of surgery to form firm conclusions.

More evidence and better evaluation of minimally invasive hip replacement will be necessary "before these techniques are recommended for more widespread clinical practice," concludes a recent advisory statement from the American Association of Hip and Knee Surgeons.

"The number of patients with dramatic benefits such as walking without [crutches or a cane] the day after surgery are very few, with surgery done by a very small subset of surgeons," Brian McGrory, MD, chairman of the expert panel that wrote the AAHKS advisory, tells WebMD.

What's more, the long-term outcomes remain unknown, says Daniel J. Berry, MD, professor and chairman of the department of orthopaedic surgery at the Mayo Clinic in Rochester, Minn.

The goal of joint replacement is to achieve "a long-lasting, well-functioning implant" that is free of complications, he points out.

"It's important for patients to understand that if there is an advantage to minimally invasive methods -- and I emphasize 'if' -- it will be for only a very short period of time, a few weeks or at most a few months," Berry tells WebMD.

"And after that, conventional methods are likely to be just as good or possibly better."

Hip Replacement Debate Heats Up

With release of the new research on complications from minimally invasive hip replacement, critics have turned up the heat.

"Is it justifiable to take patients through this learning curve?" asks Thomas S. Thornhill, MD, a professor at Harvard Medical School who uses the technique himself. "I'm troubled."

If only "miraculous" surgeons can get results, which "us lesser mortals can't," then the typical orthopaedic surgeon in the community "shouldn't be doing this operation," says Richard Rothman, MD, professor and chairman of orthopaedics at Thomas Jefferson University in Philadelphia.

For most people, the operation of choice right now is a standard hip replacement.

"We've been too polite to educate the public appropriately," says Rothman, who has taught and performed total hip replacements for decades.

"I'd go to a place that was convenient for me, where I could have good follow-up, and have a good rapport with the surgeon," says McGrory. "What I really want is a pain-free, stable hip that lasts a long time."

Hip Replacement Questions for Your Surgeon

If you're considering minimally invasive hip replacement, here are some questions to discuss with your surgeon.

What is minimally invasive hip replacement? Do you use one incision or two? How long is/are the incision(s)?

  • "Minimally invasive" is a catchall phrase describing operations with incisions shorter than the standard 8 to 10 inches used by most surgeons today.
  • The simpler of two techniques employs a single "mini-incision" of about 5 inches or less, a modification of time-tested techniques. The more demanding "two-incision" technique represents a radically new approach; in it, a surgeon performs the entire operation through two tiny portals, each incision often less than 2 inches long.
  • Beneath these small incisions loom large operations. As in any total hip replacement, the surgeon cuts off the top of the thigh bone (femur) and replaces it with an artificial stem and ball. An artificial cup is inserted on the socket side of the hip.

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