June 2004 Bulletin

Patient Information from Your Orthopaedic Connection

Small-incision hip replacement

With the aging of the population, total hip replacement has become quite common. New techniques and instruments enable the orthopaedic surgeon to operate using smaller incisions than in the past. This type of surgery is often described as “minimally invasive.” Because incisions are small, patients heal faster and are able to return to normal activities sooner.


Center, traditional incision
(10”-12”)

Left, 1-incision minimally invasive
(3”-6”)

Two small incisions, 2-incisions
minimally invasive (1”-2")

Hip-joint problems may result from:

Diagnosing hip arthritis

If your doctor suspects that you have hip arthritis, he or she will ask you about your health history, including any physical problems you have had. Your doctor will give you a physical examination and request an X-ray of your hip(s). If you have hip arthritis, the X-ray will show little or no space between the bones, which indicates a loss of cartilage in the hip socket.

Other clues are restricted movement, pain, difference in the length of your legs and an inability to walk normally. The doctor also may find bone spurs and/or bone cysts (sharp or rough spots on the bone).

Symptoms of hip arthritis

Pain and stiffness are the principal symptoms of hip arthritis. These symptoms typically begin gradually and get worse over time and with more vigorous activity. Most people have a dull, aching pain in the hip. The pain may come and go or it may be constant. Sometimes there is also pain in the groin, thigh, buttock or even the knee. Walking—especially over longer distances—may bring on a limp. Going up and down stairs can be difficult, and you may need help with ordinary daily activities like dressing, tying shoes or clipping toenails. If the pain is severe enough, it can interfere with sleep too.

Small-incision surgery

Small-incision surgery uses the same implants as a traditional hip replacement, but much smaller incisions. The surgeon also needs specially designed instruments to enable him or her to place the implants properly. With shorter incisions, the surgeon does not need to cut into as much tissue.

A surgeon who uses just one incision will make a 3” to 6”cut on the outside of the thigh. Fewer muscles and tendons have to be detached than in the traditional procedure. After the implants are in place, the muscles and tendons are repaired to help healing and prevent hip dislocation.

A surgeon also can use a two-incision technique. The surgeon makes a 2” to 3” cut over the groin to insert the socket and a 1” to 2” cut over the buttock to insert the ball and stem. A bedside X-ray machine is used to enable the surgeon to see the joint and insert the implants properly. This surgery is complicated and may take two to three times longer than traditional hip replacement surgery.

A surgeon must be trained in using the special tools that small-incision hip replacement requires. Before you decide to have this surgery, ask your surgeon how much experience he or she has had doing this operation.

Who can benefit?

Usually, small-incision surgery is recommended for patients who are young, healthy, thin and motivated to have a quick recovery. If you are considering small-incision surgery, you will need to undergo a thorough evaluation to see whether you qualify for this procedure. You should also discuss the risks and benefits with the operating surgeon.

Benefits

The benefits of small-incision hip replacement include:

Early studies indicate that minimally invasive hip replacement is safe and effective. Because the procedure is relatively new, however, there are no studies yet that show whether long-term results will be better than those obtained with a traditional hip replacement.


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