Less Invasive Approaches To Hip Replacement Surgery

Oct 23, 2019

Hip replacement surgery is a common Orthopaedic procedure with excellent outcomes. It is expected to become even more common as the population ages. In a traditional surgical approach to the hip joint the surgeon makes a 15-20 cm incision over the side of the hip. The gluteal muscles are split and the Iliotibial band incised to access the hip joint. The iliotibial band is a thick band of tissue that runs from the gluteal muscles around the hip and pelvis, down the outside of the thigh muscles to the knee. It is important in coordinating the movements of the hip and pelvic muscles and stabilizing the knee during normal walking. These structures are repaired at the end of the operation before the wound is closed. Traditional approaches to the hip joint give the surgeon excellent visualization of the joint and facilitates accurate positioning of the replacement.

Over the last decade there has been a lot of interest around minimally invasive surgical approaches to the hip joint for replacement surgery. The direct anterior approach (DAA) and the direct superior approach (DSA) are the more widely known of the minimally invasive approaches to the hip. The potential benefits of these approaches include less early post-operative pain and earlier functional recovery. This typically translates into a shorter hospital stay. What is common to all the less invasive approaches is that they do not involve incising the iliotibial band. Studies show that by the 6-8 week mark post-operatively there is no difference in function of patients treated with a traditional approach when compared to those treated with a less invasive approach. This trend reflects the healing of the iliotibial band and gluteal muscles.

Any joint replacement surgery has risk of complications. These include bleeding, nerve or blood vessel injury, infection, fracture, malposition of the implants and dislocation. Some studies have shown a higher risk of some complications with minimally invasive approaches including nerve injury, superficial wound complications and malposition of the implants. Minimally invasive surgery is not suitable for everyone and you should discuss with your surgeon what approach is best for you. Minimally invasive surgery is less suitable for patients with who are overweight or very muscular, have had previous surgery about the hip or have significant deformity of the hip joint.