Hip replacement surgery techniques are tried and tested and, although hip replacement carries some risks, it is regarded as one of the safest types of surgery to have. Surgeons still aim to improve how hip replacement is done – using longer-lasting materials and different fixing techniques for the hip prosthesis, for example.
One thing that orthopaedic specialists would certainly like to improve is the recovery and rehabilitation time for patients who have a hip replacement. The traditional surgical technique involves a long incision – 15 to 30cm is typical. The hip joint is prepared and the hip prosthesis is put in place with the whole joint exposed, so the surgeon can see exactly what is going on.
What is minimally invasive hip surgery?
This is a pioneering technique that has become possible thanks to advances in technology. It is now possible for orthopaedic surgeons to use X-ray and imaging assisted equipment that show pictures of the inside of the joint in real time on a large computer screen in the operating theatre. This enables them to position the hip prosthesis without completely opening the joint. Instead, they work from two much smaller incisions, preparing the damaged bone of the joint and inserting the hip prosthesis using a type of keyhole hip replacement surgery.
The benefits of minimally invasive hip surgery
The major advantages of minimally invasive hip surgery is that patients experience less blood loss, less pain after surgery and a lower level of surgical complications. They need to spend less time in hospital – maybe 3-4 days rather than a full week or longer – and their recovery and rehabilitation time is shorter. This is mainly because this method of hip replacement has less impact on the muscles that support the hip joint.
Is minimally invasive hip surgery good in the long term?
Although hip replacement that involves less disruption to the tissues of the hip joint is beneficial in the short term, we do not yet know the long term results. The few trials that are available show that patients fare better in the few weeks after surgery. However, there is no data available that compares pain levels, mobility and quality of life in the longer term and some experts warn that traditional hip replacement still allows the hip prosthesis to be positioned more accurately during surgery. This may explain why there seems to be a slightly higher percentage of hip revisions required 18 months, 3 years or 11 years after minimally invasive hip surgery, compared to traditional hip replacement.
For this reason, minimally invasive hip surgery is not routinely offered at most centres in the UK. The National Institute for Clinical Excellence is currently reviewing the evidence from clinical trials of the technique, and is currently inviting public consultation. NICE intends to update its specific guidelines on minimally invasive hip surgery in the next couple of years.