Minimally Invasive Total Hip Replacement

Minimally Invasive Total Hip Replacement
Minimally Invasive Total Hip Replacement
As patients begin researching their diagnosis and treatment options, they will learn about the “anterior” and “posterior” approach to hip replacement.  With the more traditional posterior approach, an incision is made along the side of the hip while with the anterior approach; the hip is accessed through an incision in front of the hip. While the posterior approach remains the “workhorse” of hip replacement surgery, the anterior approach (also known as anterior total hip arthroplasty) has gained popularity over the past few years for several reasons.

"The good news is that the success rate for this surgery is high, with a 10 year success rate of 90-95%"

What Does “Minimally Invasive” Mean?

The term “minimally invasive” is used to describe many modern medical procedures and surgeries that have been enabled by the advances of various medical technologies.  Many operations that required large incisions can now be performed via small incisions.  When “minimally invasive” is used to describe a hip replacement, it is usually referring to a procedure called “anterior hip arthroplasty” that involves using small incisions to perform a total hip replacement.   There are many advantages to this method.

When Non-Surgical Treatments No Longer Work

When non-operative treatments such as physical therapy, anti-inflammatory medications and corticosteroid injections stop working, the decision for hip replacement surgery is imminent.  If pain is chronic and persistent or if imaging tests reveal degenerative joint disease, total hip replacement surgery may offer the best chance for relief and return to normal activity.

As patients begin researching their diagnosis and treatment options, they will learn about the “anterior” and “posterior” approach to hip replacement.  With the more traditional posterior approach, an incision is made along the side of the hip while with the anterior approach; the hip is accessed through an incision in front of the hip. While the posterior approach remains the “workhorse” of hip replacement surgery, the anterior approach (also known as anterior total hip arthroplasty) has gained popularity over the past few years for several reasons.

Benefits of Anterior Hip Arthroplasty

One reason is that it is less invasive and causes less surgical trauma to the hip.  In the posterior approach, the stabilizing muscles at the back of the hip are detached to access the hip. However, with the direct anterior approach hip replacement, the surgeon is able to gain entry into the hip joint by separating muscles and ligaments rather than cutting them.  With less trauma to the muscles and tissue, pain is reduced, recovery is faster and hospital stay is shorter.  Because the stabilizing structures are not detached in the anterior approach, there is a decreased risk of dislocation. As a result, patients are placed on fewer (or no) postoperative restrictions after anterior approach surgery.

Another benefit of the anterior approach is that because the patient is lying on their back for the surgery, the surgeon is able to obtain x-rays during the operation to assess the position of the prosthesis.  The surgeon can then ensure ideal placement of the prosthesis during surgery instead waiting to obtain X-rays in the recovery room. Correct placement of the prosthesis allows accurate reproduction of the patient’s anatomy and reduces the risk of dislocation. Additionally, malposition of the prosthesis can lead to increased wear and decreased longevity of the prosthesis.

 Most People with Hip Arthritis are Candidates

Although anterior approach hip replacement has been around since the 1960s, recent advancements such as improved techniques and the use of a specialized operating table have made their approach more widespread. Most people with hip arthritis are candidates for the surgery, however the surgery is technically challenging and not all surgeons are trained in the technique. For this reason, it is important to find a surgeon who is experienced in performing the anterior approach. 

Note also that all operations carry risks.  Following the physician’s recommendations and allowing time to recover fully will lessen the chance for complications and improve overall wellbeing.  The good news is that the success rate for this surgery is high, with a 10 year success rate of 90-95% and 20 year success rate of 80-85%.  

By:  Obi Osuji, M.D – Diplomate, American Board of Orthopaedic Surgery – Adult Reconstruction and General Orthopaedics

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    Paul Spiegl, MD, PC Orthopaedic Surgeon

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