Review of Small-Incision Approaches to Hip ReplacementToday, surgeons have moved past the question of whether or not a total hip replacement (THR) can be done with one or two small incisions. We know it is, indeed, possible. Today's research is focused instead on quality and results of this minimally invasive method.
Studies so far show that the outcomes of surgery aren't much different with a long (invasive) versus small (minimally invasive) incision. In this article, two orthopedic surgeons review and summarize research comparing minimal with standard length incision for THRs.
The minimal incision method can be done from one of four directions or methods. There is the posterior approach, the anterolateral approach, direct anterior approach, and the two-incision approach.
The length of the incision is usually between one and a half and two inches. There may be one or two incisions made. The posterior approach is the most popular. The incision is made along the buttock muscles at the back of the hip. Patients are less likely to limp with the posterior incision. But the risk of dislocation is greater for patients with a small femoral head size.
The anterolateral approach starts in the same spot as the posterior incision. But instead of going down the middle of the gluteus muscles, the cut is made in front of the gluteus muscles. Blood loss and length of hospital stay are less with this approach.
The direct anterior approach has been around for 30 years. It has the advantage of giving the surgeon access to the hip through less soft tissue. However, the risk of dislocation, fracture, infection, and nerve injury is greater with this method.
The two-incision approach places one small cut along the front of the hip and one in the back. A special X-ray device called a fluoroscope allows the surgeon to view an image of the hip on a computer screen.
Computer navigation of this type gives the surgeon a more detailed image of the anatomy. This may help with placement and fit of the implant. This is very helpful when direct vision of the site isn't possible because of the small size of the incisions.
Studies show very fast early recovery with the two-incision approach. Patients may go home on the same day as the surgery. The downside is that it takes quite a bit of experience on the part of the surgeon to master the technique. And patients are exposed to longer periods of radiation.
The authors conclude that as minimally-invasive techniques for THR become increasingly popular, more study is needed on the outcomes. Rates of complications, amount of blood loss, and length of time in surgery must be studied more closely. Speed of recovery, cosmetic result, and patient satisfaction should also be considered.
Thomas P. Vail, MD, MBA, and John J. Callaghan, MD. Minimal Incision Total Hip Arthroplasty. In Journal of the American Academy of Orthopaedic Surgeons. December 2007. Vol. 15. No. 12. Pp. 707-715.
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