Facts About "Mini-Hip" Surgery –

Minimal Incision Hip Joint Replacement Surgery

Background

Total hip joint replacement surgery has been performed in the United States for almost 40 years for the treatment of disabling hip arthritis. It is one of the most successful pain-relieving operations in the United States today, with almost 300,000 procedures performed annually. The procedure is performed by many orthopaedic surgeons, who have historically used a ten-inch incision. Since the inception of this surgery, there have been numerous advances.

Early prostheses were made of metal and plastic and were "glued" in place. For over 20 years, cement-less prostheses have been utilized which eliminate the glue and allow the bone to adhere directly to the prosthesis (bone ingrowth). More recently, the use of alternative materials such as ultrastrong plastics, or even all-metal or ceramic implants promise greater longevity for arthritis surgery patients.

Recent developments in other surgical specialties such as sports medicine, gynecology, and general surgery have focused on techniques to perform procedures less invasively. Laparascopic surgery, microsurgery, and arthroscopic surgery have benefited hundreds of thousands of these patients.

Mini-Hip Surgery

Over the last several years, joint replacement surgeons have been exploring ways to adopt these techniques. Surgeons from Abington Memorial Hospital's total joint team now perform the majority of implant procedures using modern minimal-incision techniques. Although there have been numerous claims about the advantages of mini-hip surgery, the true benefits remain controversial.

However, the majority of studies have shown that the techniques are safe and effective, and are associated with high patient satisfaction. Surgeons and implant manufacturers continue to research new methods in order to develop safer and even less invasive approaches that will safely allow patients to resume their normal activities rapidly with less discomfort and inconvenience.

Single-incision Posterior Surgery

Since its introduction in 2002 at Abington Memorial Hospital's Human Motion Institute, Andrew Star, M.D. and Jeffry Rubin, M.D. have performed hundreds of single-incision mini-hip replacement surgical procedures. This approach utilizes a standard location and direction, but the incision is much smaller. Traditional total hip replacement components are used, and only a few additional pieces of surgical equipment are necessary. Similar to conventional incision surgery, the procedure takes about an hour. Rather than a radically new procedure, it is considered the natural evolution of surgical techniques applied to hip joint replacement.

Single-incision Anterior Surgery

Surgeons at Abington Memorial Hospital also perform mini-hip surgery utilizing an incision on the front of the hip joint. This particular approach utilizes a mini-incision but, unlike the previously described posterior surgery, does not disrupt the important posterior ligaments and tendons that surround the hip bone.

As a result, patients do not have to be as concerned about "hip precautions" such as avoidance of sitting, driving in a car, and bending over. This particular surgery is a modification of a surgical procedure that was previously utilized for fractured hips. Recently, its use for total hip replacements has become popular in Europe. Although long-term results of studies will take many years to be completed, the physicians of Abington Memorial Hospital's Human Motion Institute are excited about bringing this option to the region. This type of surgery may be considered an option for an active person who is interested in the potential post-operative advantages, but also recognizes the potential risks associated with newer procedures.

Two-incision Surgery

Surgeons at Abington Memorial Hospital also perform mini-hip surgery utilizing a two-incision approach. Like the single posterior incision surgery, this technique is designed to minimize the tissue trauma normally associated with hip replacement. For most average-sized patients, the two incisions will be approximately two inches long: one on the anterior thigh, just below the groin, and one on the buttocks. The advantage of this technique is to provide optimal access and positioning for the two different hip components: the socket and the femoral stem. Furthermore, this approach minimizes damage to surrounding tendons, ligaments and muscles. Recent scientific studies have questioned some of the advantages of the two-incision mini-hip replacement, particularly with regard to sparing muscles and tendons. Our experience has been favorable and patients have required fewer limitations than after conventional posterior hip surgery, but although the procedure is still performed, interest in this technique has substantially declined nationally.

Future Developments

Nationally, efforts continue in the development of the ideal hip replacement surgery. Abington Memorial Hospital is one of the leading hospitals in the region in computer-guided joint replacement. Robotic surgery, as well as even less invasive procedures, are being explored in order to further reduce the discomfort and improve the accuracy of joint surgery, perhaps looking forward to the time when they may be simple outpatient procedures. Our physicians continue to be leaders in evaluating and bringing this new technology to the region to improve the quality of life for orthopaedic patients.

The information in this fact sheet is for the general description of surgical procedures. For diagnosis or recommendation for treatment, please consult with your physician. Call 215-481-8969, or our physician referral service at 215-481-MEDI for more information.