Minimally invasive total hip replacement

One of the most significant advancements in total hip replacement is that the procedure can be done with less invasive techniques which allow the patient to recover faster. This has even progressed to the point that some patients are able to have their surgery accomplished as an outpatient procedure.

New implants have been designed to reproduce the normal motion and function of the replaced joint. These new designs incorporate new materials (metals, plastics, and ceramics) and new biologically active coatings for the implants. These materials include highly crosslinked polyethylene for the hip and knee. This new plastic has been approved by the F.D.A. for regular use in the United States. Laboratory tests have shown metal and ceramic implants to last two or three times as long as previous types.

The new implant designs can be inserted using minimally invasive techniques resulting in less trauma to the patient and the tissues surrounding the hip. The benefits for the patient are that the scar is significantly smaller and less to heal and the second major advantage is faster recovery from surgery of "smaller" magnitude. When hip replacement surgery is accomplished with smaller incisions, the patients will require fewer blood transfusions, will have shorter hospital stays and will return to work or recreation sooner. Patients report that a joint replaced with these new techniques is significantly less painful than with the previous, more generous, surgical exposures. Minimally invasive hip replacement can be performed either through two incisions each 1½ to 2 inches long or one 3 to 3½ inch incision.

We try to use this limited exposure on all patients but those patients who are significantly overweight will have a slightly larger scar and a larger, more extensive exposure.. Our first priority in performing the operation is to be able to see anatomy adequately.

Minimally invasive hip replacement surgery can be performed as an outpatient on some selective patients. In this situation, the patient receives appropriate education before surgery and then comes to the hospital the morning of surgery. After the operation, the patient is able to leave the hospital on crutches and be driven home to recover. The most current anesthetic techniques are used and appropriate medications given to minimize any risk of nausea and decrease pain.

The following pre-requisites are necessary:

1. The patient is in a stable medical condition.

• Minor medical conditions should be well controlled: hypertension, asthma, thyroid conditions, stomach or gastrointestinal problems.



• Contraindications include: diabetes, altered mental function (dementia, Parkinson's disease), obesity, unstable cardiac status, renal failure, sleep apnea, and significant prostate obstruction interfering with adequate urination.



• Age itself is not very important as long as other considerations are fulfilled.

2. The patient is willing to attend physical therapy before coming to the hospital. The patient must learn the use of crutches and the appropriate dislocation precautions before surgery.

3. There is an appropriate caregiver to help take care of the patient at home for the first few days after surgery. This is the same as for any outpatient surgical procedure.

4. The patient strongly desires to have the operation as an outpatient.

 

Treating Patients from all over California, The United States, and the World.
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