Making an Informed Decision: The Differences Between the Conventional Total Hip Replacement
and Minimally-Invasive Surgery for Hips
Picture of the hip showing the difference between a
conventional incision and the MIS incision(s)
By: Theraysa J. Richardi
In the area of total hip replacement surgery,
there are two procedures: the conventional total hip replacement and the newer
methods collectively termed, Minimally-Invasive Surgery (MIS) of the Hip.
The Incision
Both the conventional and MIS
approaches require an incision, or incisions, be made at or near the hip to
execute the procedure. The conventional
approach requires an incision be made over the hip joint, ranging from 5 to 12
inches in length. The length of the
incision, which is proportionate to the patient’s size, allows the surgeon
clear visibility and a sufficient surgical field to perform the operation.
The MIS approach can be performed
anteriorly or posteriorly through one to three incisions depending on the
surgical profile of the patient. All of
the MIS approaches usually require the use of tiny tools and flouro-optic
technology to allow visibility and proper placement of the implant. The single incision approach requires an
incision about 8 cm in length be made just over the front of the patient’s hip
socket (anterior approach) or just behind the patient’s hipbone (posterior
approach).
In addition to this 8 cm incision,
the dual-incision approach necessitates a smaller incision (sometimes termed a
stab wound) just near the original. This second incision is used to aid the
surgeon in preparing the thighbone for its component of the implant.
The three mini-surgical incision
approach, in addition to the other MIS incisions already described demands one
additional stab incision just below the original. This third incision is used to aid tool and implant maneuvering,
as well as used for the placement of suction drains in obese or very muscular
patients.
Patient Experience
Similar to the surgeons’ experience of this
procedure, the patients’ experience can also vary greatly between the
conventional and MIS approach. With the
conventional method, the patient can experience an average of 1 to 2 pints of
blood loss, soft tissue trauma around the incision, a hospital stay ranging
from 4 to 5 days, a recovery period of about 6 weeks and a scar equal to the
incision of about 5 to 12 inches in length.
In comparison, because the MIS approaches require smaller incision(s)
and go around soft tissue rather than cutting through it, surgeons who use this
technique are seeing faster recovery times, less blood loss, less post-operative
pain, a shorter hospital stay, and scars ranging from 8 cm to 3 inches in length.
Scientific
Evidence
Scientific evidence is another indicator that
these procedures are different in maturity as well. The conventional approach, with minor alterations to surgical
technique, has been done for over forty years.
There is ample evidence supporting the safety and effectiveness of this
method reported by top orthopedists and published in respected orthopedic
journals.
MIS, however, is relatively new and
has less scientific evidence supporting long-term effectiveness. Very recently though, the first long-term
findings were reported at the American Academy of Orthopedic Surgeons’ (AAOS)
70th annual meeting.
Kristapps Keggi, MD reported following over 2,000 patients for nearly 10
years and determined that the anterior approach to MIS awards patients
“…smaller incisions, less blood loss, fewer complications and earlier
rehabilitation than traditional total hip arthroplasty”. Similar long-term findings for the posterior
approach have not yet been reported.
Nevertheless, Keggi’s findings are encouraging and once collaborated
with forthcoming findings may offer a well-supported comfort to the skeptical .
Additional
Considerations
There
are some restrictions that limit eligibility to the MIS procedures. Patients
who are morbidly obese or heavier than 40% of a healthy body weight are not
good candidates for the posterior MIS technique. Also, those individuals
who have had a hip replacement in the past are not eligible to have a revision
done on that same hip via any of the MIS approaches. For a revision surgery,
the conventional method is the only option to date.
There is an ongoing orthopedic
debate over what technique is best, but the most important question may be
this: What technique is most appropriate for the surgical candidate? It is now up to you and your surgeon to
decide the best course of action for your condition.