Minimally Invasive (MIS) Total Hip Replacement

Total hip replacement has been refined over the last decade. Hip replacement can be done more safely, with shorter hospitalizations, with less discomfort and fewer complications--as long as careful attention to detail is combined with state-of-the-art techniques. One of the more recent refinements of this technique allows the operation to be done through a smaller incision.

Historical Perspective

The surgical approach and the size of the incision is a critically important element of hip replacement surgery. The success of this operation is largely related to the surgeon’s ability to gain adequate exposure to the arthritic hip joint. Component position is affects stability, long term performance, and leg lengths. For most patients, a 10 – 14 inch incision is still considered standard and necessary.

However, not all patients need the standard incision. Recent enhancements in surgical technique andinstrumentation have allowed more limited surgical approaches in certain patients. The use of these instruments, selected implants, and minor modifications of the surgical dissection allow hip replacement to be done through a 3 to 4 inch incision. The potential but unproven benefits of this less invasive technique are significant:

Better cosmetics
Less postoperative pain
Less blood loss
Earlier rehabilitation
Fewer wound complications

It is important, however, to understand that small incisions for hip replacement are a recent development. Precise placement of hip components remains the primary goal of the surgery, and this goal should not be compromised for a smaller incision. Patient factors such as weight, stiff hips, previous hip surgery, and hip deformity can require the standard sized incision. Patients who are interested in this approach need to appreciate that there are very important and specific requirements:

Careful patient selection
Specialized retractors
Surgical team accustomed to the approach
Specialized components

The American College of Rheumatologists has called total joint replacement "The single greatest advancement of arthritis treatment in this century." Improved surgical techniques, development of new materials, and the evolution of detailed preoperative and postoperative protocols have all led to enhanced results in hip replacement. The “mimimally invasive approach” allows hip replacement to be done through a smaller incision. Hopefully, this approach will also lead to better postoperative recovery.

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