Faster Recovery After Total Hip Replacement Based on Type of IncisionOrthopedic surgeons at the Mayo Clinic in Rochester, Minnesota compared speed of recovery in hip replacement patients. They used two different surgical approaches. Patients in both groups were similar in age, diagnosis, and background. Everyone was treated using the same advanced anesthetic and rehab protocols.
The first group was managed with a two-incision technique. One six-centimeter (about two and a half inches) incision was made across the front of the hip. Another smaller incision in the buttock gave surgeons access to the hip. Hip muscles were protected from surgical disruption.
The second group had the mini-posterior-incision method. A seven to 9.5-centimeter (three and a half inch) incision was made along the back of the hip. With this approach, the fascia over the muscle and the muscles of the hip and buttock were split and moved during the procedure. After the implant was in place, then the muscles and soft tissues were repaired.
The surgeons expected a faster recovery time with the two-incision method. Instead, they found that patients treated with the mini-posterior-incision had the advantage. The mini-posterior-incision group was able to walk faster and farther with less assistance sooner than the two-incision group.
The mini-posterior-incision group also returned to daily activities sooner. They were able to start driving, climbing stairs, and walking one-half mile before patients in the two-incision group.
The authors suggest that early improvements in pain and function with minimally invasive surgery may really be the result of other factors. Careful patient selection, new anesthetic techniques, and improved control over postoperative pain may be the true reasons why hip replacement patients recover faster.
New, aggressive rehab programs may also have an influence in speed of recovery. Patients are allowed to put weight on the leg and walk without a walker, crutches, cane or other walking aid as soon as they feel up to it. Patients can advance in their function at their own pace.
The two-incision method of hip replacement is complex and requires considerable skill on the part of the surgeon. Operative time is longer without the benefit of faster recovery. There may not be enough advantages of the two-incision method to use it to replace the mini-posterior-incision approach.
Mark W. Pagnano, MD, et al. Slower Recovery After Two-Incision Than Mini-Posterior-Incision Total Hip Arthroplasty. In The Journal of Bone & Joint Surgery. May 2008. Vol. 90-A. No. 5. Pp. 1000-1006.
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