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...
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.
How many operations have you done with your current techniques?
- Each technique has its own learning curve. For the mini-incision technique, "it is short, probably about 10 cases," suggests Allan E. Gross, MD, professor and chairman of orthopaedic surgery at the University of Toronto.
- For the two-incision technique, however, surgeons should do a minimum of 50 two-incision operations per year, suggests Gross.
- "Patients should recognize that if they're going to use a minimally invasive method, they need to be skeptical about whether or not that procedure can be done at the present time by most surgeons with as low a complication rate and as high a durability as conventional methods," suggests the Mayo Clinic's Berry.
- "Is it hard? Of course it's hard. Should you go to someone with experience and training? Of course," says innovator Berger.
Are the short-term results of minimally invasive hip replacement any better than those for standard incisions?
- Two provocative clinical trials presented at the AAOS meeting suggest the mini-incision technique offers little more than a shorter scar. One trial from Belfast, Northern Ireland, compared more than 200 patients. The other trial, led by Jefferson's Rothman, involved 120 patients.
- Though the short- and long-incision operations were equally safe, none of the hoped-for advantages of the mini-incision technique materialized in either trial. "The size of the incision doesn't matter," Graham Bailie, MD, a co-researcher of the Irish trial, told WebMD.
- As for the two-incision technique, researchers haven't yet presented head-to-head trials comparing it with a mini-incision or standard technique.