Minimally Invasive Hip Replacement (cont.)
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Minimally Invasive Hip Replacement Preparation
Being educated about what to expect is important after minimally invasive hip replacement surgery. Candidates for the procedure are educated on both the benefits and the risks of minimally invasive hip replacement surgery. The patient and his or her doctor determine if this procedure is right for them.
The term minimally invasive surgery is somewhat misleading. It is still a surgery, and any type of surgery is invasive. The human response to injury is predictable, and it includes discomfort, altered emotions, and a period of recovery until healing occurs. Minimally invasive surgery can reduce, but not eliminate, these normal responses to the trauma of surgery. Minimally invasive surgery also does not mean risk-free surgery. Hip replacement surgery, regardless of technique, is associated with risk of infection, nerve injury, deep blood clots, premature implant loosening and failure, unpredictable medical complications, and even death. While these complications are uncommon, one needs to be aware of them before embarking on any type of hip reconstructive procedure.
Usually, minimally invasive surgery simply means performing a big operation through a small incision. In other words, the deep tissue and muscle injury is often unchanged, but the physical appearance of the scar is smaller. Surgeons who typically perform at least 100 hip replacement procedures per year are most able to adopt minimally invasive surgery. They progressively shorten the incision while keeping the procedure the same. Using special instruments, the surgeon can shorten the incision of a standard hip replacement from 8-12 inches to about 4 inches. This person only spent two days in the hospital.
Many orthopedic implant companies (who manufacture the biomaterials used in hip replacements) have developed special instruments and training for surgeons. Reviewing the patient educational material provided on an orthopedic implant company's Web site, such as Zimmer, Inc., can be useful in learning more about the procedure. The Web site can help identify the surgeons in an area who use a particular company's implants, including those who have attended special seminars on minimally invasive surgery and are therefore qualified to safely perform the procedures.
One of the methods used to perform minimally invasive hip replacement is a procedure called the MIS-2-incision hip replacement. Hip replacement procedures performed with a shorter incision are considerably different from MIS-2-incision hip replacements. The MIS-2-incision hip replacement is often described as same-day hip replacement. It is a different way of performing hip replacement surgery.
The approach is not new. Several decades ago, pioneer hip surgeons described the surgical pathway to the hip joint from the skin. What is new is using two incisions that are only 1-2 inches in length. Importantly, once the surgeon makes the cuts, the rest of the procedure involves moving around the muscle layers without cutting them. Special instruments, implants, and fluoroscopic guidance are needed to perform an MIS-2-incision hip replacement. Fluoroscopic guidance requires an x-ray machine and computer to project the image on a video monitor. MIS-2-incision hip replacement is a technically demanding technique that is best left to very capable surgeons.
Besides greatly reduced pain after surgery, the MIS-2-incision technique offers a very early return to walking. The overall recovery is faster than that for hip replacements that are done through a 4-inch incision using standard techniques.
B Sonny Bal, MD
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