By John T Dearborn, M.D.
Institute for Joint Restoration and Research
Washington Hospital Healthcare System
If you are suffering from chronic hip pain due to arthritis or traumatic injury and have tried other treatments such as medications and physical therapy with no improvement, you might want to investigate whether or not hip replacement surgery may be an option for you.
With hip replacement surgery, the surgeon removes the damaged joint surfaces and replaces them with an artificial implant. Years ago, that surgery entailed an extensive incision, a lengthy hospital stay and months of rehabilitation. Today, though, minimally invasive hip replacement surgery techniques dramatically reduce the amount of post-operative pain and significantly shorten the hospital stay and recovery period.
Traditional Hip Replacement
Traditional hip replacement surgery, in practice since the 1960s in the United States, has typically utilized an extensive, 5 to 10 inch curved incision on the side of the hip, extending into the buttock area. The deep portion of the dissection divides a number of important stabilizing muscles and tendons and ends with removal of the dense fibrous capsule of the hip joint. The actual size of the incision depends on the size of the patient. Although this approach affords wide exposure to the posterior half of the hip joint, it also leads to a predictably large blood loss and significant rehabilitation time.
Minimally Invasive Hip Replacement
A handful of hip replacement specialists in this country have developed specialized techniques and instruments to allow the same operation to be done with a very limited incision and dissection. The skin incision is typically two to three inches in length. Direct visualization of the hip joint is still possible because of special lighting instruments and retractors. The deep structures, including the capsule, are repaired after the prostheses have been implanted. This exposure is less extensive, and therefore surgeons utilize these techniques with special expertise in hip anatomy and minimally invasive surgery (MIS) techniques.
The advantages of this approach are many, including reduced operative time, decreased blood loss, fewer postoperative dislocations, reduced pain, and a faster recovery for the patient. The length of stay in the hospital has also been reduced to approximately two days. These improvements have also made hip replacement surgery available to many patients with health problems severe enough to preclude the traditional procedure.
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