FAQs – Minimally Invasive Knee & Hip Techniques
Total arthroplasty is an operation, where orthopedic inserts are placed and replace the damaged parts of a big joint in our body. The orthopedic inserts can be metal, polyamide, ceramic or even plastic. The total arthroplasty can successfully recover the functionality of a damaged limb, the range of motion of the affected joint and eliminate the pain of arthritis.
The anterior approach of the joint, also known as AMIS, is a surgical technique that is used recently in total hip arthroplasty. This operation does not cut the muscles and requires a minimal invasive incision on the skin and on the underlying fat tissue. It leads to less blood loss from the wound, reduction of the postoperative pain and quicker recovery.
It is a specific type of arthroplasty, where orthopedic inserts and the osteotomy tools and instruments are made in a personalized way according to the patient, taking into consideration the specific anatomy-morphology of the bones and the joint elements. With this arthroplasty, the quicker adaptation of the orthopedic inserts is ensured as well as the wide range of hip joint motion without stiffness.
In the operating room, there are specific navigation systems and “passive robotic systems” that give crucial information to the surgeon, regarding load bearing axis of the limb, specific anatomical-morphological points and simulation of a normal knee, with an exceptional placement of the orthopedic inserts, the even distribution of loads in the medial and lateral knee compartment and the longevity of the insert. In Orthopedics, there are not any robotic systems, as in other medical specialties, that perform the operation on their own with only the guidance of the surgeon, but here the surgeon performs the surgery with the guidance of the system.
Total arthroplasty is an operation that is performed pretty often nowadays and is considered a very safe procedure. On an annual basis, in the USA alone, around 150.000 hip and 250.000 total knee arthroplasties are performed. The numbers for our country are 10.000 and 15.000 surgeries respectively. The potential risks and complication will be analyzed to you by your attending physician.
Usually 10-15 years, but with the modern material that we use in the contact interfaces, such as ceramics and biological plastics (e-poly) the survival of the orthopedic inserts is almost doubled in duration.
Usually there aren’t any complications when operations are performed in a properly equipped operating room, with an experienced and specialized in such surgeries medical and nursery personnel. The risk of complications does not exceed the 1% in total and this includes two main categories, the infection and the vein thrombosis. They are avoided by the administration of antibiotics and antithrombotic drugs.
What holds a significant role in this kind of operation is the “biological” age of the patient and other intercurrent health problems that may make this operation potentially life threatening for the patient. Fortunately, the modern diagnostic instruments helps us a lot in the handling of most conditions, while the progression of the orthopedic inserts along with the minimal invasive surgical techniques have highly increased the age range of the patients that may be subjected to an operation like this.
Usually, simple blood and biochemical routine screening, along with a cardiac check are sufficient in about 90% of the cases. Your attending physician will receive a complete cardiac and respiratory medical history and will direct you to an additional diagnostic and/or therapeutical check, if he/she deems it necessary. Moreover, specific type of x-rays of the affected limb will be required, a CT scan or an MRI for the documentation of specific anatomical-morphological abnormalities in cases of a personalized insert.
You will discuss this with your attending physician. As a general guide, we would say that most of the drugs that you are taking for other conditions, except for arthritis, are allowed until the date of your surgery. If you take drugs for your heart or for hypertension, you may take them orally even in the morning of the surgery. The drugs that you must interrupt or replace, according to the opinion of your doctor, 5-7 days prior to the surgery are the antithrombotic, the anti-cholesterol and anti-inflammatory drugs.
You can be subjected to a general or spinal anesthesia. In the latter case, you will feel a numbness in your feet. The spinal anesthesia can be combined with (Neurolipton) anesthesia and in this case you will not feel anything in the operating room. This kind of anesthesia helps a lot the patient right after the surgery, since it provides the necessary analgesia, while it allows the mobility of the limbs, so that the patient can be mobilized just 4-5 hours after the operation. In any case, you will discuss the type of the anesthesia before the operation with the senior anesthesiologist of the group.
Usually the operation time does not exceed the 50-60 minutes, but you will estimate that you will be absent from your room for approximately 3 hours, since it takes time to prepare the operating room and after the surgery you will remain in recovery for the measurement of your vital signs of your organism, before transferring you back to your room.
Our medical personnel is specialized in the treatment of chronic pain. Most of the patients feel just a slight discomfort and difficulty in movement, but not pain, during the first postoperative days. In the majority of cases, even these discomfort disappear after approximately 2 weeks since the operation.
For around 5-6 weeks, although with the “rapid recovery” method that we are currently using, we could limit this specific time period. You can take them off during sleep or noon rest, but you will need to wear them during the whole day and your daily occupations.
Usually 2-3 days, since our medical team applies international protocols of “rapid recovery”. In the cases of patients, without intercurrent health problems, of young age and without postoperative pain, discharge from the clinic can be made even on the same day of the surgery.
Ideally you would have a friendly or relative person around you for the first days. If this is not possible, someone should at least check you in a 24h basis, in case you need something.
Usually a painkiller for around 2 weeks would be enough. Moreover, you will need an antithrombotic drug orally for approximately 30-35 days, in order to avoid the risk of vein thrombosis.
Most patients, especially when they do not face other problems in their muscolosckeletal system, can be discharged the clinic walking with full weight-bearing. As far as walking is concerned, patients are independent from the 2nd – 3rd day post operation. However, in case that just for safety, you want to hold a walking stick for a few days, this is not considered as a contra-indication.
Most patients can climb up and down the stairs before their discharge from the clinic. In order to gain this kind of ease, you will need approximately 20 days, until the extensor mechanism is fully recovered.
A legal assurance is provided after the 5th-6th week. However, rules always have their exceptions. Driving an automatic car, with a left operated limb and a good general health condition of the patient, may be allowed in an earlier stage, always according to the opinion of your attending physician.
Most patients return after the 6th week, although in reality there are significant factors, such as the type of operation, the general health condition, the age and the type of work (office work) that may speed up the safe return to work.
Your attending physician will give you a schedule of the standard visits. Usually we see patients at 3,6 and 12 weeks post operation and once every year.
Usually it takes several weeks before you return to a mild sports activity, such as cycling, swimming and mild running. Everything depends on the type of the operation, the limitations that your attending physician sets and the progress of the physiotherapeutic rehabilitation.