Minimally Invasive Hip Replacement Surgery

 

What is Minimally Invasive Hip Replacement Surgery?

The purpose of Total Hip Replacement Surgery is to remove and replace the two damaged and worn parts of the hip joint.  

These joints are the hip socket (acetabulum) , and the ball, (femoral head). They are replaced with smooth, artificial implants called prostheses, which will help make the hip strong, stable and flexible again.

Minimally Invasive Hip Replacement Surgery Preparation

Before your departure your records will be reviewed thoroughly by our orthopedic surgeon.

This includes X-rays and a complete medical and surgical history as well as your specific issues. In addition, you may be asked to consult with a physical therapist to discuss recovery, hip rehabilitation and important precautions you must take postoperatively.

The physical therapist may even give you exercises you can begin prior to your surgery in order to aid with recovery.

After traveling to Cyprus, a new set of X-rays will be taken as well as an in person physical examination. The surgeon and anesthetist will also go through your medical and surgical issues with you. During this visit, your surgeon will also review your hip replacement procedure and answer any questions.

 

Getting your house ready before your surgery

It is also important to get your house ready for your return home. At first it will be harder for you to move around, so arrange your furniture and household items ahead of time to make it easier for you during your rehabilitation.

• Remove all your throw rugs or anything on the floor that may cause you to trip.
• Move phone and electrical cords close to the walls.
• Add pillows or cushions to the chairs you will be using after surgery to make sure that your hip is above the level of your knees when you are seated. This will lessen the risk of dislocation of your new hip.
• Arrange to have an elevated toilet seat or support bars fitted to your bathroom before you leave the hospital.
• Move necessary personal items you need to reach to shelves and tables that are above your waist level. You should not be bending past 90 degrees during rehabilitation.

Preparation for the hospital

Here are a few things to keep in mind as you pack and prepare for your surgery and recuperation in Cyprus:

Clothing
Be sure to bring some comfortable clothing:

• Loose shorts or pants
• Loose tops or T-shirts
• Underwear and socks
• Short robe or pajamas
• Toiletries
• Walking aids - If you are already using one, leave it at home. We will provide any aids you need upon your discharge from the hospital, for the duration of your stay with us.

THE PROCEDURE

Traditional total hip replacements typically require an incision between 8 to 10 inches long. The patient’s size and the extent of the joint’s damage can sometimes determine the length of the incision. The incision allows the surgeon to fully visualize the joint, the diseased bone, and the implants.

Minimally Invasive Techniques refers to approaches using smaller incisions of approximately 2 to 4 inch, combined with traditional approaches. Surgeons can perform surgery through such a short incision because they use instruments specifically designed for minimally invasive hip replacement.

There are 3 surgical approaches your surgeon can employ for Minimally Invasive Surgery and he will choose which technique best suits your needs:

     The Anterior Approach.

Anterior means front. So this technique, called Direct Anterior Approach (DAA), uses one small incision (6-8 cm) on the front of the upper thigh. The technique allows the surgeon to work between your muscles and tissues without detaching them from either the hip or thighbones - sparing the tissue from trauma. Other approaches advertised as minimally invasive (posterior, lateral, or double incision) are only reduced skin incision techniques and are associated with the same muscle and/or tendon injury as “conventional” approaches. Therefore the DAA is a real minimal invasive and muscle sparing technique.

The benefit of using the DAA is minimal pain and rapid recovery for the patient.

There are several advantages of this technique:

• The patient during the operation is in the supine position. That means that it’s very easy for the surgeon to measure the leg length and to avoid any postoperative leg length discrepancies.
• Because there is no muscle trauma, there is no postoperative limbing.
• A C-arm (means fluoroscopy / x-rays) can be used during the operation. This is very important because the surgeon can check under fluoroscopy the proper position of the components. Applying the components in the proper position has a direct effect to clinical result and the longevity of the implants as well.
• The postoperative pain is minimal. The patient usually is mobilized with a walker the same day of the surgery.
• The early mobilization reduces the incidence of deep vein thrombosis and subsequently the incidence of pulmonary embolism.
• There are no precautions (legs in abduction, avoidance of extreme flexion, partial weight bearing for 6 weeks etc.).
• Short hospital stay. Usually the patient stays in the hospital 1-2 days after the operation.
• The majority of the patients underwent a total hip replacement with the anterior approach are able to walk independently in the first 7 days after the procedure. 9 to 10 patients are visiting surgeon’s office for suture removal, 14 days postoperatively, by driving their own car.

The DAA can also be used for the surgical treatment of the neck of femur fractures.

 

     The Posterior-Lateral and Anterior-Lateral Approach.

These are traditional approaches using smaller incisions and special instruments to facilitate the procedure through these incisions.

     Two-Incision Technique

Two-Incision Technique uses one opening nearer the front of the thigh to insert the socket part of the implant and a separate small incision toward the back of the thigh to insert the stem of the implant.

Your hip joint is made up of two parts: the socket, in your hip or pelvic bone, and the ball, at the top of your upper leg bone (femur). Your surgeon will perform the planned approach and will reshape the socket to fit the new cup implant that replaces your diseased socket.

The hip implant is comprised of four parts that work together to restore the original function of your ball-and-socket joint:

• A metallic hip stem that is inserted into the top of your thighbone
• A metallic cup which holds the cup liner
• A polymeric cup liner which holds the femoral head
• The femoral head or ball which is attached to the hip stem and inserted into the liner to form the ball-and-socket joint

Hip implants are not one-size-fits-all; therefore our orthopedic surgeon will choose the right hip implant for your body. Our surgeon will determine which design options will work best together to restore accurate leg length, while minimizing risks of dislocation and premature implant wear.

After the socket is reshaped, a new cup will be placed in the socket. The cup usually consists of a metal shell and a polyethylene or metal liner.

Your surgeon then prepares your femur for the femoral stem, which will hold the new ball part of your hip joint. The head of your femur is removed and the bone is prepared for the new femoral stem. Your surgeon will most likely use a trial implant to verify the correct fit.

After your permanent hip stem is implanted, the ball that sits at the top of the femoral stem will be put into place.

A high-tech operating table is used to help improve access and intraoperative x-ray /computer navigation is typically used to confirm implant position and leg length. Once your surgeon is satisfied with the position and movement of your new hip joint, it will be flushed with cleansing fluid and closed.

 

MIS TOTAL HIP REPLACEMENT SURGERY RECOVERY

After surgery, you will be taken to the recovery room for a period of observation. The staff will monitor your blood pressure, heart rate, respiration and body temperature. Special attention will be given to your circulation and sensation in your feet and legs.

When you awaken and your condition is stabilized you will be transferred to your room. Before leaving the hospital, your surgeon and the hospital staff will help you adjust to recovery in every way possible. They will show you safe techniques of simple activities like getting in and out of bed, bathing, going to the bathroom, managing steps at home and getting in and out of a car. Progress varies from patient to patient, so discharge instructions may also vary. You will receive specific precautions from your orthopedic surgeon, nurse and physical therapist.

MIS Total Hip Replacement Surgery Advantages

The performance of a hip replacement depends on your age, weight, activity level and other factors. Each patient responds differently, however you should expect:

• With the Anterior Approach, there are fewer restrictions during recovery. Patients typically are able to freely bend their hip and bear their full weight immediately or soon after surgery
• Possible reduced scarring because of small incision
• With the Anterior Approach, there is potential for stability of the implant sooner after the surgery, resulting in part from the fact that the key muscles and tissues are not disturbed during the operation. 
• With the Anterior Approach, there is no need for physiotherapy after the surgery
• Less bleeding during surgery
• Less post-operative pain
• Shorter recovery time

Rehabilitation after MIS Total Hip Replacement Surgery

Your own diligence regarding physical rehabilitation is one of the most critical factors in achieving an efficient recovery from hip replacement surgery. You must actively participate in the rehabilitation process, working on your own as well as with your physical therapist to achieve optimal results. Where necessary, the physical therapists will begin working with you as early as a day after surgery. They will teach you simple exercises that can be performed in bed to strengthen the muscles in the hip and lower extremity.

Your physical therapist will also teach you the following proper techniques. Although these activities may seem simple, you must learn to do them safely so that the hip does not dislocate or suffer other injury.

• Moving up and down in bed
• Going from lying to sitting and vice versa
• Going from sitting to standing and vice versa

Another important goal for early physical therapy is for you to learn to walk safely with your walker, crutches or other assistive device. Our orthopedic surgeon will determine how much weight you can bear on your new hip and the therapist will teach you the proper techniques for walking on level surfaces and stairs with your assistive device.

 

LIFE AFTER MIS TOTAL HIP REPLACEMENT SURGERY

The postoperative recovery is very fast: with the Anterior Approach, most patients are able to walk without their crutches and to climb the stairs 24 hours after the surgery because absolutely no muscles have been cut, so there is no need for physical rehabilitation. 

In the first week following surgery you may experience:

• Swelling – From your thigh down into your foot is common. This at times may be quite marked. The swelling will increase for the first few days after surgery and will gradually diminish. Some swelling can be present for 12 months or so. The swelling may be diminished by walking as the muscle function will push the fluid away. When you stop walking, the limb should be elevated above the level of the hip.
• Bruising – Marked bruising can be found in some patients. This can be found from your thigh down into your foot. At times the bruising can be quite dramatic but it will resolve. It is the result of some residual bleeding making its way to the surface. The body will eventually remove the bruising. It is also the result of the blood thinning tablets you will be taking.The blood thinning tablets will tend to make the bleeding after surgery a little more marked because the blood clotting is impaired. This is however preferable to developing a blood clot.
• Blistering – On occasions blisters will develop near the operation and possibly above it. The blistering is due to surface fluid. It looks dramatic but it is of no consequence and always resolves. One cause may be the bandage rubbing on the skin. Sometimes, when the blood dries in the bandage it can be like cardboard and rub on the skin producing these blisters. We change the bandage after about a week but would prefer not to interfere with that earlier because of the risk of infection. After about a week the wound is sealed enough to be a reasonable barrier against infection. Another cause for the blistering is tissue swelling. This is associated with the bruising and is a result of fluid leaking into the skin. These blisters always go away. They may burst and leak fluid and again the appearance may be dramatic. Sometimes if they are large we may burst them. This is so that the dressings sit more comfortably.
• Muscle soreness – Your muscles can feel stiff and sore to touch. During the operation some stretching and pulling of the muscles occurs. This may result in some pain like a corked thigh. Occasionally you may feel cramps and spasms. The discomfort however will resolve and activity such as walking, stretching, physiotherapy, etc, will help to speed the improvement.
• Heat – The operated site may feel hot and the heat may last for 12 months. As part of the healing process the operation site requires more blood supply from the body and it is this extra blood supply which is the cause of the local heat.
• For the first 2 weeks after surgery your activity level is usually limited however you will be able to walk independently, use the bathroom and perform normal activities of daily living. If you have had anterior surgery hip bending is not restricted.
• After 2 weeks you will be able to engage in moderate activities, such as driving a car and climbing stairs.
• Within 6 weeks you should be able to resume most of your normal activities. Complete surgical healing takes 6 – 8 weeks. You should have a near-normal range of motion and adequate strength in your hip to perform most daily activities after completing the post-operative hip rehabilitation process. During this time some swelling and discomfort is normal and should be manageable with the prescribed medication.
• At two months after MIS Total Hip Replacement Surgery, patients have effectively returned to walking, driving, swimming, golf, doubles tennis, stationary cycling and gardening. However, care should always be taken. You should generally avoid high-impact activities such as running, vigorous walking and downhill skiing. Remember to listen to what your body tells you.