Minimally Invasive Hip Replacement (cont.)
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After the Procedure
Many surgeons combine a small incision with spinal and epidural anesthetics to facilitate recovery. Newer anesthesia drugs reduce the nausea and confusion experienced upon awakening. Local anesthesia injected into the surgical site relieves pain after surgery.
With current minimally invasive techniques, the person is encouraged to become mobile much earlier than with standard methods of hip replacements. Many people are able to get out of bed either the same day or the next day, with the help of a physical therapist.
Pain pumps that infuse painkillers into the incision, patient-controlled analgesics, and newer antiinflammatory drugs may all be combined to speed recovery.
Even though modern surgery can facilitate recovery and reduce the risk of blood clots, minimally invasive procedures cannot eliminate the risk of a clot. Some method or a combination of methods for reducing the likelihood of blood clots after surgery is still necessary. Draining the wound, medications that prevent blood clots (anticoagulants) that are given by mouth or injection, and even leg-squeezing devices that provide constant intermittent pressure are used to decrease the risk of developing deep blood clots. Additionally, medical support stockings, such as TED hose (tight elastic stockings that help prevent blood clots in the legs), may also be used. People who are prescribed certain anticoagulant medications (blood thinners) are required to have their blood drawn to measure their protime (prothrombin time, or how fast the blood clots). Measuring the protime guides the doctor in adjusting the anticoagulant to the optimal dose.
Traditional Hip Replacement Surgery
A person can expect to be on crutches or to use a walker for six to eight weeks. The person should not support full weight on the affected hip. Repaired muscles should not be exercised. The newly implanted hip ball can come out of the socket until the muscles have healed. Specific hip precautions must be followed, in some instances, for a person's lifetime. A hospital stay of three to six days is typical for traditional hip procedures.
Minimally Invasive Hip Replacement Surgery
With minimally invasive surgery, reasonable precautions are still necessary for the first six to eight weeks while the tissue is healing and uncemented implants are bonding to the person's bone. Since less tissue is traumatized, fewer precautions may apply. With the MIS-2-incision technique, restrictions apply for the first six weeks, after which a person can gradually resume full activities without any hip precautions. Most surgeons restrict driving for about four weeks following any type of procedure.
Some of the accelerated recovery can be attributed to better anesthetic techniques and newer medications that improve recovery. Research is underway to determine what role anesthetic techniques and decreased surgical trauma have in aiding recovery. Even with the traditional procedures, newer anesthetic techniques improve recovery and lead to a faster return of function.
B Sonny Bal, MD
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