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Total hip replacement is a common procedure. It involves
removing the head of the thighbone (femur). The ball-and-socket
mechanism of the hip is replaced with artificial implants.
As the population ages over the next decade, this procedure is expected
to become even more common. Patients who undergo hip replacement are
typically 60 to 75 years old. More than 90 percent of hip replacements
last for 10 years or more. Pain and mobility improve after hip
replacement. This allows patients to maintain their independence and
quality of life.
Newer techniques and implants have been developed. They make hip
replacement a less invasive operation. It takes less time for the
patient to recover from surgery. The new implants are engineered to last
longer.
Treatment Options: Surgical
Traditional Hip Replacement: The doctor may recommend hip
replacement when all of the above measures have been considered or have
been tried and failed. Traditional hip replacement surgery involves
making a 10-inch to 12-inch incision on the side of the hip. The muscles
are split or detached from the hip. The hip is dislocated. The ball of
the femur is removed. The hip socket is prepared by removing any
remaining cartilage and some of the surrounding bone. The cup implant is
pressed into the bone of the socket. It may be secured with screws. A
bearing surface is inserted into the socket.
Next, the femur is prepared by removing some bone from the inside of the
thighbone. A metal stem is placed into the thighbone to a depth of about
6 inches. The stem implant is either fixed with bone cement or is
implanted without cement. Cementless implants have a rough, porous
surface. It allows bone to adhere to the implant to hold it in place. A
ball is then placed on the top of the stem. The ball-and-socket joint is
recreated.
Minimal Incision Hip Replacement: Minimal incision hip replacement
surgery lets the surgeon perform hip replacement through one or two
smaller incisions. Compared with most people getting hip replacements,
candidates for minimal incision procedures are typically thinner,
younger, healthier and more motivated to have a quick recovery. Before
you decide to have a minimally invasive hip replacement, get a thorough
evaluation from the operating surgeon. Discuss with him or her about the
risks and benefits. Both traditional and minimally invasive hip
replacement procedures are technically demanding. They require that the
surgeon and operating team have considerable experience.
The artificial implants used for the minimally invasive hip replacement
procedures are the same as those used for traditional hip replacement.
Specially designed instruments are needed to prepare the socket and
femur and to place the implants properly. The artificial hip is
implanted in the same way. But there is less soft-tissue dissection than
with longer incisions.
A single minimally invasive hip incision may measure only 3-inches to
6-inches. It depends on the size of the patient and the difficulty of
the procedure. The incision is usually placed over the outside of the
hip. The muscles and tendons are split or detached, but to a lesser
extent than in the traditional hip replacement operation. They are
routinely repaired after the surgeon places the implants. This helps
healing. It helps prevent dislocation of the hip.
Two-incision hip replacement involves making a 2-inch to 3-inch incision
over the groin for placement of the socket and a 1-inch to 2-inch
incision over the buttock for placement of the stem. To perform the
two-incision procedure, the surgeon needs guidance from X-rays. It may
take up to two or three times as long to perform this surgery, as it
takes to perform traditional hip replacement surgery.
Reported benefits of less invasive hip replacement include:
Less pain
More cosmetic incisions
Less muscle damage
Rehabilitation is faster
Hospital stays are shorter--For traditional hip replacement, hospital
stays average four to five days. Many patients need extensive
rehabilitation afterward. With less invasive procedures, the hospital
stay may be as short as one or two days. Some patients can go home the
day of surgery.
Early studies suggest that minimally invasive hip replacement surgery
streamlines the recovery process. But the risks and long-term benefits
of the less invasive techniques have not yet been documented to
represent an improvement over traditional hip replacement surgery.
Research on the Horizon/What's New?
Extensive study and development are now underway to determine the
long-term benefits of minimally invasive hip replacement. New technology
for imaging and computer-assisted implant placement has been developed.
It continues to be modified as experience with smaller incision surgery
grows. This will allow more precise reconstruction of the hip with less
direct visualization. In addition, new implant designs and materials are
being developed to both facilitate minimally invasive surgery on the hip
and to prolong the lifespan of replacements.
October 2004
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