Total hip replacement (also called hip arthroplasty) is a common orthopaedic procedure that is used to replace the damaged or worn surfaces of the hip joint. Replacing these surfaces with an implant or “prosthesis” will relieve pain and increase mobility, allowing you to return to your normal, everyday activities.
The traditional approach to hip replacement uses a long vertical incision in the center of the greater trochanter to view and access the joint. Minimally invasive total hip replacement is a variation of this approach. The surgeon uses a shorter anterior incision and a different, less-invasive technique to expose the joint—with the goal of reducing postoperative pain and speeding recovery.
This is the most modern development of the surgical technique in hip surgery, in which, unlike the conventional access, the hip joint is replaced, through a very small incision, without any muscles, blood vessels and nerves injury in order t to restore a normal gait, reduce postoperative pain and provide a faster recovery of the patient.
Unlike the conventional total hip replacement, the minimally invasive technique is not suitable for all patients and requires surgeon’s skill and expertise, as well as skilled surgical team.
TRADITIONAL HIP REPLACEMENT
To perform a traditional hip replacement, the surgeon makes an 15- to 20-cm vertical incision over the greater trochanter to expose the joint. The surgeon will then:
- Prepare the bone.The damaged cartilage surfaces at the ends of the femur and acetabulum are removed along with a small amount of underlying bone.
- Position the metal implants.The removed cartilage and bone is replaced with metal components that recreate the surface of the joint.
- Insert a spacer.A plastic or ceramic spacer is inserted between the metal components to create a smooth gliding surface.
MINIMALLY INVASIVE HIP REPLACEMENT
In minimally invasive hip replacement, the surgical procedure is similar, but there is a different access and greater retention of soft tissues, surrounding the hip. Artificial implants used are metal alloys, much lighter than those used for the conventional hip replacement, not oxidized and fully demagnetized. Also, specifically designed surgical instruments are used to prepare the femur and acetabulum as well as proper positioning of the implants.
The minimally invasive hip replacement is done through a smaller incision (about 1/3 of classic hip arthroplasty). The smaller incision allows less tissue disorder. It is less invasive. Generally, the techniques used in minimally invasive hip replacement maintain all the muscle groups surrounding the hip joint intact , while the visibility of the joint is achieved by the use of a specific for the procedure operating table, or manipulation techniques achieved by the assistant surgeon. The experience of the surgeon and the availability of specialized surgical team, are integral to the success of the operation.
Many and varied are the advantages offered by new surgical technique in patients with hip problems. The main ones are:
- Negligible postoperative pain compared with “conventional” surgery, as the whole procedure is a not muscle sparing technique.
- Immediate mobilization. walking with or even without crutches, can be performed only a few hours after surgery .
- Minimum hospitalization. On average, the hospital stay is limited to two or three days even if in exceptional cases, the patient can be discharged the same day.
- Minimum scar the skin. The skin incision is 4 to 5 cm, as opposed to 15-20cm in “conventional” intervention . It’s position is aesthetically excellent
- Faster return to daily activities. After about one week, patients can return to work, drive carefully and perform comfortably with their daily activities.
- Minimal blood loss due to the small incision, retention of muscle groups and careful haemostasis. Blood transfusions are rare, and the formation of blood clots in the legs (deep vein thrombosis) are potentially less likely.
- Reducing hospital costs. The reduction in hospitalization and pharmaceutical pain killers lead to reduced hospitalization costs.
- Minimizing postoperative physiotherapy sessions.
- Minimum probability of dislocation. Maintaining muscle and soft tissue around the joint improves the stability of the hip . The risk of dislocation is minimal and postoperative restriction of movement, which is usually recommended to other techniques, is not necessary
- Prevent leg length discrepancy.
The technique maintains the normal anatomy of the hip region, facilitating future interventions in the area and can also be applied with equal success to hip fractures and revisions surgery of the hip, with the same advantages.
It requires the cooperation of a specialized surgical team, requires expertise by the surgeon and technique learning curve, as prerequisites for optimal clinical and functional outcome of the patient.