Is minimally invasive hip-replacement surgery right for you? Before you decide, consider the pros and cons.
Asked whether they would rather have traditional hip-replacement surgery or a less invasive procedure, most people would choose the "mini” hip-replacement procedure instinctively. Minimally invasive hip-replacement surgery can be a good choice. But it’s not right for everyone, and not all orthopedic surgeons are experienced in the minimally invasive techniques.
Moreover, the mini-procedures have not been evaluated in large, scientifically rigorous studies with long-term follow-up. As a result, it’s not clear whether orthopedic surgeons actually achieve the proposed benefits of the surgeries in their day-to-day practices or how their patients’ new hips fare over time.
Potential Benefits of Mini-Procedures -- The idea behind minimally invasive hip-replacement surgery is that smaller incisions and less tissue disruption should involve less pain, less blood loss, and shorter hospitalization and that rehabilitation should be faster. Results from several small studies generally support these potential advantages. After minimally invasive hip-replacement surgery patients typically leave the hospital in one to two days instead of four or five, and some patients go home the same day.
But not all studies have documented these advantages. Some orthopedic surgeons also point out that the advantages of minimally invasive hip-replacement surgery are realized in the early post-surgery period. They are not known to affect the long-term function of the new hip.
Traditional Hip-Replacement Surgery -- In traditional hip-replacement surgery, the surgeon makes a 10- to 12-inch incision along the side of the hip. Surrounding muscles and tendons are separated from the hip or split and pushed aside. The hip is then dislocated, and the head ("ball”) of the femur (thigh bone) is removed.
The surgeon cleans out the hip socket, removing remnants of cartilage and cutting away some of the bone. A cup-shaped metal shell is pressed into the socket, and a smooth plastic liner is secured to the shell. The surgeon then hollows out the end of the femur to make room for the metal stem implant. Bone cement is placed in the hollowed-out space (unless a cementless implant is used), and the metal stem is inserted. Finally, a metal ball is attached to the top of the implant, the new ball-and-socket is put together, and the tissues are repositioned and sutured.
Minimally Invasive Hip-Replacement Surgery -- The actual implantation procedure during minimally invasive surgery is similar to that of traditional hip-replacement. The mini-hip-replacement procedure can be performed with a single incision or two incisions. In single-incision surgery, an incision only 3–6 inches long is placed over the outside of the hip. The muscles and tendons are moved out of the way but suffer less trauma than in the traditional surgery. In the two-incision surgery, a 2- to 3-inch incision is made over the groin to insert the socket, and a 1- to 2- inch incision is made over the buttock to implant the stem.
The smaller incisions require special surgical instruments and limit the visibility of the surgical area. In the two-incision surgery, the surgeon must rely on x-rays or use a computer-assisted hip navigation system to position the new hip. The minimally invasive procedures are technically challenging and have a definite learning curve. For a surgeon who is just learning the new technique, it can take longer than traditional hip replacement.
Long-Term Outcomes -- Minimally invasive hip replacements have not been performed long enough to be able to evaluate how well the implants stand up over time. Research conducted so far has not found a long-term advantage (or drawback) to having a minimally invasive procedure rather than a traditional operation. In one study, researchers found no differences in patients’ pain or hip function year after surgery, regardless of which procedure they had.
If you are considering minimally invasive hip-replacement surgery, be sure to find a surgeon who has been doing the new procedure for several years. Also keep in mind that the advantages of the mini techniques are mostly on the front end of the process. In the long run, the most important concern is that you have a well-functioning, pain-free hip that will last for many years.
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Posted in Arthritis on November 26, 2007
Reviewed July 2009
