Is Less-Invasive Hip Replacement Best for You?
Finding the right surgeon and asking the right questions can help determine if minimally invasive hip replacement is right for you.
Reviewed By Michael Smith
Less cutting sounds like a good thing when it comes to hip replacement. But experts say knowing the right questions to ask is key to determining if this new technique is for you.
Research recently presented at a meeting of orthopaedic specialists shows that patients often fare no better with minimally invasive hip replacement than those having a standard hip replacement -- and may do worse.
Proponents of minimally invasive hip replacement say small-incision operations can lessen blood loss, ease post-operative pain, trim hospital stays, improve scar appearance, and speed healing. In the hands of properly trained surgeons, they say, patients can expect benefits that were once unimaginable.
Richard A. Berger, MD, who refined the technique, says most of his patients go home the same day as surgery and can walk without crutches within eight days. He says his technique steers clear of muscle and tendon damage during surgery. Berger is assistant professor at Rush-Presbyterian-St. Luke's Medical Center in Chicago.
But critics say minimally invasive hip replacement is overhyped and underproven. The scientific evidence supporting it has come from a small group of enthusiastic innovators, they point out. Poor positioning of hip implants during surgery can occur more frequently, in turn leading to hip dislocations and pain in the short run or failure in the longer term.
And the learning curve can be perilously steep. In one new study, the complication rate using a highly touted technique in an experienced surgeon's first 80 patients was nearly four times higher than normal. The complications were also disproportionately more serious. The study was presented during the recent annual meeting of the American Academy of Orthopaedic Surgery in Washington, D.C.
Experts advise patients who are considering minimally invasive hip replacement to educate themselves on the pros and cons of the operation and choose their surgeons carefully.
Wanted: Better Evidence
Experts say there is simply not enough scientific evidence about this new form of surgery to form firm conclusions.
More evidence and better evaluation of minimally invasive hip replacement will be necessary "before these techniques are recommended for more widespread clinical practice," concludes a recent advisory statement from the American Association of Hip and Knee Surgeons.
"The number of patients with dramatic benefits such as walking without [crutches or a cane] the day after surgery are very few, with surgery done by a very small subset of surgeons," Brian McGrory, MD, chairman of the expert panel that wrote the AAHKS advisory, tells WebMD.
What's more, the long-term outcomes remain unknown, says Daniel J. Berry, MD, professor and chairman of the department of orthopaedic surgery at the Mayo Clinic in Rochester, Minn.
The goal of joint replacement is to achieve "a long-lasting, well-functioning implant" that is free of complications, he points out.
"It's important for patients to understand that if there is an advantage to minimally invasive methods -- and I emphasize 'if' -- it will be for only a very short period of time, a few weeks or at most a few months," Berry tells WebMD.
"And after that, conventional methods are likely to be just as good or possibly better."
Hip Replacement Debate Heats Up
With release of the new research on complications from minimally invasive hip replacement, critics have turned up the heat.
"Is it justifiable to take patients through this learning curve?" asks Thomas S. Thornhill, MD, a professor at Harvard Medical School who uses the technique himself. "I'm troubled."
If only "miraculous" surgeons can get results, which "us lesser mortals can't," then the typical orthopaedic surgeon in the community "shouldn't be doing this operation," says Richard Rothman, MD, professor and chairman of orthopaedics at Thomas Jefferson University in Philadelphia.
For most people, the operation of choice right now is a standard hip replacement.
"We've been too polite to educate the public appropriately," says Rothman, who has taught and performed total hip replacements for decades.
"I'd go to a place that was convenient for me, where I could have good follow-up, and have a good rapport with the surgeon," says McGrory. "What I really want is a pain-free, stable hip that lasts a long time."
Hip Replacement Questions for Your Surgeon
If you're considering minimally invasive hip replacement, here are some questions to discuss with your surgeon.
What is minimally invasive hip replacement? Do you use one incision or two? How long is/are the incision(s)?