If you're considering hip surgery, you can reduce recovery time and pain with minimally invasive hip replacement surgery. The surgery involves an anterior approach to the hip. Traditional hip replacements performed in the U.S. use the posterior or lateral/posterior approach. Over the years, a smaller incision with the traditional approach has been used and is less invasive, but it still requires following strict hip restrictions.
The Minimally Invasive Anterior Approach
The anterior approach to hip replacement has been quite successful with the vast majority of total hip replacement patients, including hip fractures. After the surgery, the patient is free to move his hip without restrictions, and, in most cases, is up and walking later that same day. A patient's hospital stay is also shortened to 2-5 days.
After traditional hip replacement, patients must strictly follow their hip precautions.
Minimally invasive hip replacement is performed while the patient is lying flat on his back. A small incision (about 4 inches) is made at the front of the hip joint, as opposed to the traditional lateral or posterior incision. During the anterior approach, the hip is replaced without detachment of muscle from the femur or pelvis. The hip is reached through a natural opening between the muscles. This results in a quicker rehab and a shortened hospital stay.
Traditional hip replacement requires a large incision through the gluteal muscles, which are the most important muscles for hip function. This places restrictions on hip movement for a period of time after surgery. Restrictions (referred to as hip precautions) include no internal rotation, no leg crossing, and no bending of the hip beyond 90 degrees. Often times there are also limitations on the amount of weight a patient is allowed to place on his leg while walking. These restrictions are in place to prevent dislocation of the new hip.
Minimally invasive hip replacement (anterior approach) eliminates restrictions because muscles and tissue are left intact in the lateral and posterior areas. This provides stability for the hip and greatly reduces the chance of dislocation.
Minimally invasive surgery doesn't necessarily refer to the size of the incision. It has more to do with the minimal amount of tissue damage during surgery. The incision can't be made too small or else the incision area becomes too stretched in an attempt to reach the hip joint.
ProFX Operating Table
The ProFX is a special operating table that positions the patient's leg for the anterior approach. Not all hospitals have this table. Without it, the anterior approach isn't performed. For instance, in California there are less than 10 hospitals that perform this minimally invasive procedure. Another reason for the scarcity of this approach lies with surgeons. Most orthopedic surgeons have been trained in the lateral and/or posterior methods only.
Advantages of Minimally Invasive Hip Replacement (anterior approach)
- No limitations on hip motion
- No weight bearing restrictions
- Decreased chance of hip dislocation
- Reduced hospital stay
- Shorter rehab time
- Quicker return to functional mobility
- Quicker return to driving your vehicle
- Much less pain from surgery
- Reduces chance of leg length discrepancy
Disadvantages/Complications
Complications are rare but are similar to complications from traditional lateral and posterior approaches. These include infection, DVT (deep vein thrombosis), nerve damage, femur fracture, and revision surgery. Dislocation is a complication, but is much less likely to occur.
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