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.
Hip Replacement Questions for Your Surgeon continued...
- "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.
Underneath the skin, is the operation the same as a standard hip replacement?
- Advocates of minimally invasive hip replacement say it reduces damage to muscles and tendons. Advocates of the two-incision technique say it completely eliminates muscle and tendon damage. But there is conflicting evidence for both claims.
- In a study presented at the AAOS meeting, researchers from the Mayo Clinic performed two-incision operations on 10 cadavers. The surgery "cut or damaged measurable amounts of muscle or tendon in every case," they concluded.
What are the potential limitations of a minimally invasive hip replacement?
- During minimally invasive hip replacement, surgeons sometimes can't see what they're doing. Potentially, this can result in improperly positioned implants -- which could dislocate, cause pain, or wear out faster.
The Reality of Complications
Are there complications unique to minimally invasive hip replacement? How serious? What is your own personal experience with complications?
- Two studies at the AAOS meeting provided unsettling clues about complications with two-incision operations. In one series of 80 patients from the Mayo Clinic, 14% of patients suffered complications -- nearly four times higher than normal. Problems included seven fractures of the femur and one deep infection.
- Patients at the University of Missouri at Columbia suffered a similar fate. Nine of 87 patients (10%) required a second hip operation within six months and 22 (25%) suffered nerve injury -- three to four times the normal rate of problems.