A New Minimally Invasive Total Hip Replacement?

In mid-2006 , the minimally invasive total hip replacement went from the two-incision surgical approach in our hands to a single , small incision. The surgical procedure is identical to the two-incision total hip replacement that is described in detail elsewhere on this web site. The difference is even less surgical trauma, since we can now eliminate one surgical incision entirely.

Total hip replacement through just one small incision placed in front of the thigh has been developed by the renowned trauma surgeon , Dr. Joel Matta of Los Angeles , California. For a detailed description of his technique , which we now use routinely in our practice , visit http://www.hipandpelvis.com/patient_education/totalhip/index.html. No muscles or tendons are cut during this surgical approach. Instead, the surgeon separates muscles along their natural, anatomic planes to reach the hip joint. The pelvic (socket) part of the hip replacement, and the femoral component are both inserted this way. Another excellent resource for information about this type of hip replacement surgery is www.newhipnews.com.

To insert the femoral stem into the femur (thigh bone), the surgeon previously had to make a second short incision further back, in the buttock area. That was the minimally invasive two-incision hip replacement method. Both components can be inserted during the two-incisino technique without cutting muscles or tendons, with less surgical trauma when compared to other methods of hip replacement.

In expert hands, the two-incision hip replacement procedure has radically changed hip replacement surgery since patients can recover faster , leave the hospital sooner , and hurt less than with standard approaches that cut muscle and damage tendons. Also, with the two-incision hip replacement , patients need follow no precautions to avoid dislocation, which is a feared complication of hip replacement surgery.

As of mid-2006, we stopped making the second incision in the minimally invasive two-incision hip replacement. Instead , the femoral stem is implanted through the single incision already made for the socket insertion. To accomplish this , a special fracture table is used. This is called the HANA table. Details can be viewed at http://www.osiosi.com/hana.cfm. This equipment, first used in Missouri at Capital Region Medical Center in August 2006, allows the patient’s leg to be gently moved so that all of the hip replacement can be done safely through just one small cut.

The advantage of less surgery is self-evident. The hip replacement can be implanted with just one small cut , with all the advantages of a two-incision total hip replacement. With this advancement, the patient recovery is improved yet further and outcomes are even better on average, when compared to the two-incision minimally invasive total hip replacement.

The two-incision hip replacement technique is still new for most surgeons and represents a big improvement , at least in our experience , in terms of patient comfort , recovery , and improved outcomes. In our practice, as of mid-2006, the two-incision minimally invasive hip replacement was already obsolete, and replaced by the newer, even less traumatic single-incision method described here.