Hip arthroplasty: modern minimally invasive methods

Replacing a diseased hip joint is sometimes the only treatment option.

All this can be avoided by advanced minimally invasive technologies, which allow to carry out joint replacement preserving the integrity of muscles, vessels, nerves, tendons, as well as reduce the period of postoperative recovery and ensure a quick return of patients to normal life, including unlimited sports activity.

Prosthesis implantation with minimal tissue damage - a new word in orthopedic surgery

Hip arthroplasty is one of the most frequent types of surgery performed in modern medicine. The procedure has a decades-long history. Attempts to implant a "new" artificial joint made of various materials had been made with varying degrees of success since the second half of the 19th century.

Since then, the models have been constantly improved, and the most reliable materials have been sought for their manufacture. But the operation technique as such remained more or less traditional. Doctors used the standard approach involving an incision of muscle fibers, vascular and nerve bundles, as well as other tissues. The recovery process after such an operation, even if it had been perfectly performed, was quite long and painful.

Fortunately, orthopedic surgeons managed to develop an alternative hip replacement technique now being widely put into practice, which makes it possible to preserve all anatomical structures. This is the so-called minimally invasive arthroplasty.

Through a small incision, an endoscopic probe and operating tools are inserted. Thus, this keyhole-like opening makes it possible to perform surgery with maximum tissue preservation.  Basically, this can function with the hip joint as well.

Also, the so-called non-imaging navigation systems have proven themselves to be very good in daily clinical practice. They use infrared cameras and do not involve any radiation exposure. The systems permit precise three-dimensional control of artificial joint component placement. The aim is to position the implant in such a way that it complies with the patient’s individual anatomy. This enhances the function of the prosthesis and optimizes the range of limb motion.

What happens during minimally invasive hip replacement procedure?

The surgery is performed under general anesthesia. The approach is made through a small skin incision, after which, unlike in the traditional technique, the surgeon “finds his way” to the hip joint between the muscles. That is, the muscles, tendons, and nerve bundles are moved as far apart as possible. This provides the decisive advantage of this technique, since no muscle fibers are cut, and the amount of total damage remains relatively small.  At the same time, the surgeon has full visibility and can treat all affected areas to the necessary extent, eventually setting the implant in its proper place. After this step is completed, a short functional test to check the mobility of the artificial implant is performed, followed by flushing and closing the wound.

What are the benefits of the gentle technique?

The technology has a number of obvious advantages.

• Muscles, blood vessels, nerves and surrounding tissues remain intact.
• Patients experience less pain after surgery because the tissues are not dissected.
• There is less need for analgesics.
• Patients recover soon.
• Blood loss in significantly reduces as compared to open surgery.
• It is possible to enhance rehabilitation with the help of physiotherapy.
• Only a small scar remains.
• There is no post-operative gait disturbance or limping.
• After surgery, there is good mobility and almost total preservation of muscle strength.
• The ability to walk and stand is regained much sooner.
• Due to the early mobilization, the risk of thrombosis is reduced.
• The risk of dislocation of the prosthesis is lower, since the surrounding stabilizing muscles are preserved.
• The length of hospital stay is shortened.
• It takes patients less time to return to normal daily life to its full extent, including unrestricted sports activities.
• For an experienced surgeon, the technique is not a challenge even in heavily muscled or overweight patients.
• If revision or implant replacement is necessary, the access incision can be widened and the muscles can be left intact.

When are there reasons to use minimally invasive techniques?

The most common reason for hip replacement is age-associated wear and tear, which healthcare professionals refer to as coxarthrosis. The process of physiological aging of the hip joints progresses steadily after 30 years of age.

Additionally, the erosion of the thin layer of articular cartilage is accelerated by injuries, posture disorders, and other circumstances. The result of this process is severe pain on movement, as well as increasing mobility restriction.

Replacement, as a rule, is considered when all previously tried conservative treatment methods are no longer effective.

General indications

Before deciding between the non-traumatic or the standard arthroplasty procedure, one should check if there are solid reasons for joint replacement at all.

From the point of view of modern medicine, surgery is indicated if:

• There is significant damage to the structure of the hip joint;
• At least a 3-month conservative therapy (pain killers, movement therapy, weight loss, etc.) has not led to sufficient improvement;
• Quality of life has notably deteriorated due to pain and limited motion range.

Once the basic indications for arthroplasty have been identified, the healthcare provider and the patient together proceed to choose the method by which the procedure is to be performed.

What patients have limited indications for using the gentle technique?

Unfortunately, not every patient with severe coxarthrosis is suitable for this in so many ways attractive treatment option.

Which type of procedure is the best depends on such factors as the history of complex joint surgery, the implant type as such, the way it is fixed in the bone tissue, as well as the degree of hip joint damage. 

Doctors believe that the minimally invasive surgical technique can not be applied in the following cases:

• previous hip surgeries;
• bone deformities;
• scars in the surgery zone;
• severe excess weight.

Prognosis

Novel hip replacement technologies require that a surgeon should be highly-qualified, possessing a solid experience, special skills, and taking a great deal of care.

As a rule, such surgeries, provided that they are performed by competent specialists, do not involve significant complications. Motor therapy begins on the following day.

Approximately on the second or third day after the procedure, patients can walk on their own, aided by crutches. The latter should be used for support for a total of four to six weeks.

An important factor contributing to the success of minimally invasive hip replacement is early and high quality rehabilitation in an inpatient or outpatient facility.

References

1. Hüfttotalendoprothese: minimalinvasiver anterolateraler Zugang. Andreas Roth. Springer Berlin, Heidelberg. 2023
2. Minimally Invasive Surgery in Total Hip Arthroplasty. English edition  by Joachim Pfeil, Werner E. Siebert. Springer; 2010th edition (23 Feb. 2010).