Minimally Invasive Hip Replacement Surgery

More and more Spaniards, due to different circumstances, are forced to undergo surgery to have a hip prosthesis implanted. All patients, practically without exception, are terrified when they begin to learn about the “legends” of the operation, which include the painful postoperative period and the long recovery process, which can take up to six months.

However, the panorama has changed thanks to the fact that traumatology has caught the Minimally Invasive Surgery (MIS) train, into which other medical disciplines have already fully entered. With this procedure, which we have been using at IQTRA Advanced Medicine since 2004, the patient only stays in the hospital for 3 to 4 days, is off crutches in the first few weeks post-operatively and is walking normally and pain-free in approximately one month.

All surgeons have dreamed at some time of being able to access the inside of their patients’ bodies and clearly visualize the interior of their organism in order to locate the focus of the disease as precisely as possible. Once they know where the problem is, they have to go in to solve it and, for years, the only way to do this was to use a scalpel to open a door that would expose the source of the disorder.

Aware of the collateral damage left behind by this journey into the human body, surgeons have been reducing the size of these openings and, at present, there are hundreds of surgical procedures that only leave a scar no bigger than a scratch.

Traumatology has evolved in this sense and nowadays its specialists are crazy about the excellent expectations offered by MIS for the implantation of total hip prostheses, an operation that more than 30,000 Spaniards undergo every year.

What are the advantages of MIS for hip prostheses?

The superiority of this surgical approach is unquestionable, since minimally invasive surgery involves much less soft tissue injury, which translates into less bleeding during surgery (and thus less need for blood transfusions), less pain (less analgesic medication), faster healing, quicker patient recovery and a lower risk of complications.

Conventional hip surgery involves significant bleeding, so it is not uncommon to have to transfuse blood; however, with this technique it is not necessary and is a major advance. By the same token, a smaller incision means less chance of infection, as the space through which pathogens can enter is much smaller. Likewise, the risk of dislocation (a complication that occurs when the femoral head slips out of place) is also, among other factors, in proportion to the size of the wound. The smaller the surgical injury, the lower the chance of dislocation.

What is the recovery from MIS hip replacement like?

Once the damaged hip has been replaced by the prosthesis, the patient will be able to start walking with crutches a few hours after the operation. After 3-4 weeks he/she will be able to get rid of these supports and after a month he/she will be able to walk normally and without pain.

Conventional surgery, on the other hand, causes trauma to the soft tissues (muscles, tendons, skin and blood vessels), which takes longer. The patient is not only in great pain but also feels that he or she cannot move the leg or rest it on the ground because, as they themselves say, “I try to move, but my body does not respond”.

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“The body starts up a defense mechanism in response to this aggression and blocks, so to speak, the limb, which does not begin to be operative until the pain is reduced,” explains Dr. Angel Villamor. However, with minimally invasive surgery and specific instruments “all these tissues remain practically intact, so without pain, functionality is recovered much sooner,” comments the iQtra medical director.

How long will the hip prosthesis last?

So far we have mentioned the surgical technique, but prosthetic materials have also advanced considerably and bring great benefits to the patient. A few decades ago, older prostheses had a certain ease of loosening from their anchorage to the patient’s bone.

However, today’s prostheses are covered with a porous metallic material that anchors very well to the bone and it is much more difficult for them to loosen. The second handicap that the prostheses had is that the friction material, which really simulated the joint, ended up deteriorating and wearing out to the point that every 10 years they had to be replaced; the entire prosthesis had to be removed from the bone in order to fit a new one.

Current prostheses have solved this problem with two new features: the friction materials, which are very sophisticated, last up to 30 years, so that replacement is no longer every 10 years; but also, the friction pieces are modular pieces that can be replaced without the need to remove the prosthesis from the bone, but only by renewing those intermediate moving parts, which wear out because they are the ones that suffer the friction, which means a much less aggressive surgery than the first one. The rest of the prosthesis will remain anchored to the bone without needing to be touched.

What complications are there with MIS of hip prosthesis?

With all that has been explained so far, it might seem that hip prostheses implanted in the traditional way are pointless, but this is not the case. The less invasive method has its complications and contraindications.

  • Severe obesity. In this case, the layer of fat that surgeons have to deal with is so large that a wider surgical field is required to be able to act with guarantees.
  • Other pathologies. Congenital dysplasias that require additional operations, pins or screws implanted in the area (due to previous fractures) are sometimes incompatible with this minimally invasive technique.
  • Excessive musculature. The operation is performed more easily when the skin and muscles are more lax, since the tissues offer less resistance.
  • Learning curve. Any surgeon properly experienced in implanting hip prostheses in the usual way will soon become accustomed to the new procedures. However, we must not forget that the surgeon must be comfortable with the approach, for which it is highly recommended that his experience in this field be as extensive as possible.