Minimally Invasive Total Hip Replacement
The hip joint is one of the body's largest weight-bearing joints and is the point where the thigh bone (femur) and the pelvis (acetabulum) join. It is a ball and socket joint in which the head of the femur is the ball and the pelvic acetabulum forms the socket. The joint surface is covered by a smooth articular cartilage that cushions and enables smooth movements of the joint.
Hip arthritis is a common and painful disease of the hip joint caused by damage to the cartilage. Total hip replacement surgery is an option to relieve severe arthritis pain that limits your daily activities.
Traditionally, total hip replacement was performed through a 10–12-inch-long incision made on the side of the hip. A minimally invasive approach has been developed in recent years where surgery is performed through a smaller incision and less damage to deep tissue. Advantages of the newer approach are lesser muscle dissection, less pain, quicker recovery, and faster rehabilitation.
The most common symptom of hip arthritis is dull, aching joint pain and stiffness resulting in limited mobility. There may be pain in the groin, thigh and buttock area and sometimes pain may be referred to the knee. Vigorous activity and walking for long distances can increase the pain and stiffness which may cause limping while walking.
Diagnosis is made by evaluating your symptoms, medical history, physical examination and X-rays. In rare cases, additional imaging tests such as MRI and CT scans may be needed to confirm the diagnosis.
Surgery may be recommended in patients with severe cartilage damage where conservative treatment options such as anti-inflammatory medications and physical therapy do not relieve the symptoms.
For minimally invasive hip replacement, the surgical technique and artificial implants remain the same as traditional hip replacement; however, the skin incision is typically smaller and there is less dissection of deep tissue and muscle. Dr. Schwartz is one of a handful of surgeons to offer the Direct Superior approach to hip replacement which furthers the concept of minimally invasive, no muscle cutting surgery. For more information see: https://patients.stryker.com/hip-replacement/procedures/direct-superior-approach
In single incision minimally invasive approach, your surgeon makes a 3–6-inch incision over the side of the hip to expose the hip joint. The muscles are minimally dissected to reach the joint. The femur is dislocated from the acetabulum. The surface of the socket is cleaned and the arthritic bone is removed using a reamer. The acetabular implant is inserted into the socket and is initially held in place tightly with friction. A liner material of plastic is placed inside the acetabular component and serves as the new substitute cartilage of the joint. The femur or thigh bone is then prepared by removing the arthritic bone using special instruments and shaped to exactly fit the new metal femoral component. The femoral stem is then inserted into the femur either by a press fit similar to the socket. The femoral head component made of metal or ceramic is placed on the femoral stem. The muscles and tendons around the new joint are repaired and the incision is closed.
The advantages of minimally invasive total hip replacement as compared with traditional total hip replacement may include:
- Smaller incisions
- Shorter hospital stay
- Less trauma to the surrounding tissues
- Quicker recovery
- Less blood loss
- Less scarring
- Faster rehabilitation
- Less post-operative pain
After undergoing minimally invasive total hip replacement, you will be provided a separate instruction sheet regarding your recovery. In general, you should gradually return to normal activity as pain and mobility allow. Strict precautions are not usually necessary; however, it is recommended that you avoid pushing the hip beyond what is comfortable.
Risks and Complications
As with any major surgical procedure, there are certain potential risks and complications involved with total hip replacement surgery. They include:
- Injury to nerves and blood vessels
- Formation of blood clots in the leg veins
- Implant malposition
- Fracture of the femur or pelvis