Since it was first performed more than 50 years ago, hip replacement surgery has become one of the safest and most effective methods of treating patients diagnosed with osteoarthritis. Procedural innovations and improvements in prostheses (artificial joints) have drastically improved patients' results. Today, patients have more options than ever to treat hip arthritis surgically, including minimally invasive hip surgery, which may provide potential benefits over traditional hip replacement.
Hip replacement surgery involves the removal of the diseased hip joint, and replacing it with an artificial implant made of metal, plastic, and possibly ceramics. The goal is to provide pain relief and restore activities of daily living, giving the similar feel and function of a natural hip. Traditionally, hip replacement required a very large exposure, thereby necessitating extensive muscle detachment. Surgical incisions were typically 12 inches or more. This resulted in a prolonged recovery taking up to 3 months or longer. Many patients deferred surgery because of fear of anesthesia, blood loss and anticipated pain.
Minimally invasive hip replacement is similar to traditional hip replacement, but differs in surgical approach. The prosthetic components are identical; however, the surgical instruments used are specially designed for minimally invasive procedures.
During a traditional procedure, muscles and tendons are detached from the hip joint; however, minimally invasive techniques lessen the dissection of soft tissue. With minimally invasive procedures, muscles and tendons are split and detached, but to a lesser degree.
Minimally invasive hip replacement surgery allows the surgeon to perform the procedure through smaller incisions, which can potentially provide benefits including:
Minimally invasive hip surgery can be performed through an incision that is usually 6 inches or less. The size of incision is based on the patient's unique case, and is influenced by both the patient's size and the difficulty of the procedure.
Dr. Harwin has been a proponent of the anterior approach to hip and has used it for over 25 years. This approach allows him to perform the reconstruction from the front of the joint, thereby creating a more stable joint with less risk of infection and dislocation. It also provides better visualization of the structures so that positioning of the implants is more accurate. Dislocation means that the new joint is unstable and comes out of place, requiring a procedure in the hospital to put it back. Dislocation rates after hip replacement done through other approaches can be as high as 2-3%, but using the anterior approach, Dr. Harwin’s dislocation rate using his anterior approach is less than 0.2%
The Anterior approach allows the procedure to be done safely and rapidly. It is done using local anesthesia techniques, with medication given so that patients do not hear or feel anything, but no general anesthesia is necessary. Patients breathe on their own, with no tube in the throat. Therefore the recovery is faster. A typical surgery takes about 45 minutes to implant the prosthesis, and blood loss is typically minimal. Over 95% of Dr. Harwin’s patients have hip replacement without the need for blood transfusion.
The anterior approach allows for early mobilization with virtually no restrictions after surgery. Patients can walk and sleep comfortably and move their hips in any direction. They are usually recovered enough to return to work, driving, and travel by 3-4 weeks after surgery. Dr. Harwin will explain the indications for each procedure.
Benefits of the anterior approach to hip replacement include:
As a designer of several hip (and knee) replacement implants, Dr. Harwin uses implants that are proven to be effective. In fact, implants that Dr. Harwin helped design have been implanted in more than 2 million people worldwide. For patients wishing a high level of activity, Dr. Harwin will speak with you about the MDM® (Modular Dual Mobility) Hip Replacement by Stryker. Dr. Steven Harwin is one of the most well-trusted and knowledgeable hip surgeons in New York City. To learn more about minimally invasive hip replacement and treatment options for hip arthritis, schedule an appointment at Dr. Harwin's office in Manhattan, NYC.
By Dr. Steven Harwin