Deutsches Ärzteblatt announces the annalysis results:
Minimally invasive hip replacement surgery has met with great interest in the lay press - there are far fewer scientific foundations on this topic.
As with all new procedures, minimally invasive surgery (MIS) for hip replacement should be discreetly promoted in the lay media until it has been thoroughly assessed in peer reviewed journals.
MIS techniques are currently among the most notable innovations in the field of surgery. In the last five years, the hip replacement effort was made to limit the skin incision to a maximum of 10 cm or to use several mini-accesses at the same time. The theoretical concept of MIS in total hip arthroplasty is not limited to smaller incisions. It involves less tissue damage, reduced bleeding and less pain, as well as a rapid postoperative burden while maintaining the high standards of safety, efficiency and longevity of the implanted endoprosthesis.
Advantages of minimally invasive techniques in the implantation of hip endoprostheses
For the patient, the most noticeable difference is the cosmetically shorter incision. However, this does not affect the quality of the operation positively. The short skin incision even entails the danger that it may lead to false implantation in the absence of an overview. For some access techniques, advocates therefore require intraoperatively to use an X-ray monitor control and / or a navigation system. From a biomechanical point of view, the protection of the abductor muscles is much more important. The resulting functional gain for the patient has a very positive effect especially in the postoperative early phase. Proprioception is also a clinically relevant benefit that benefits better early rehabilitation.
Originally one expected also with a smaller blood loss and with reduced postoperative pain. However, this benefit did not materialize in all studies. In addition, a faster wound healing was expected. It should also be noted in MIS that wounds heal side-to-side and not end-to-end, so a short incision does not bring any benefit. Improper procedures may even be more likely to cause skin problems with the short incisions due to the hook tension and pressure.
Intraoperative image converter control / navigation system
An operation-specific intraoperative image converter control is principally indicated in the case of the double portal technique. In other techniques, their use depends on the experience of the surgeon. However, the imager is still used to complete the operation prior to anesthesia delivery to document the location of the implant. The use of a navigation system is recommended by some authors. Mostly, however, the interventions are carried out without a navigation system.
For most access techniques, all standard hip endoprostheses can be used. Advantageous are anatomical hip endoprostheses, which allow to leave the femoral stem preparation as far as possible medially, in order to protect the approach of the M. gluteus medius. The implantation of surface prostheses is also possible with hip joint via MIS access. Here, antero-lateral minimally invasive (ALMI) techniques for head preparation may even be beneficial because the femoral head turns out of the wound during external rotation due to the antetorsion from the wound into the surgical field.
Hip replacement - when is the right time?
Whenever any movement of the hips is painful, those concerned often ask themselves: how long do I have to wait for hip replacement? Is hip replacement as soon as possible the best solution - or should physiotherapy delay the procedure?
When the hip hurts, there is often an arthrosis behind it. The wear of the cartilage is the most common reason for a hip replacement. Around 200,000 people receive a hip prosthesis every year in Germany alone. But there are also other causes that can lead to chronic hip pain: congenital hip deformity, rheumatic diseases, metabolic circulatory disorders, inflammation, metabolic disorders or accidents.
Hip replacement is considered a routine intervention among experts. The entire hip replacement usually takes between 40 minutes and one hour. Hip replacement is considered one of the most common and successful operations ever. If it succeeds, it frees the patients from pain, increases the quality of life and ensures mobility into old age. Most often, a total hip replacement is made.
When should I talk to my doctor about a hip replacement?
That's a question that you need to answer with your orthopedic surgeon. If the hip pain is so severe that it affects your quality of life, this is certainly an appropriate time.
Your family doctor may refer you to an orthopedic surgeon who will help you determine if or when the time has come for a hip replacement, and what type of hip replacement is best for you. Your surgeon may decide that hip replacement is not appropriate in your case if you have an infection or not enough bone or if the bone is not strong enough to support an artificial hip.
Doctors usually try to delay hip replacement as much as possible and use less invasive procedures. However, if you suffer from advanced joint disease, hip replacement can help you to relieve pain and restore a normal life.
Over the last 40 years, millions of people suffering from hip pain and arthritis have experienced both palliation and restored mobility thanks to total hip replacement. Hip replacements and revision surgeries are performed each year by nearly one million people worldwide.