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Is Less-Invasive Hip Replacement Best for You?
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.
Avascular Necrosis (Osteonecrosis)
Avascular necrosis (AVN), also called osteonecrosis, aseptic necrosis, or ischemic bone necrosis, is a condition that occurs when there is loss of blood to the bone. Because bone is living tissue that requires blood, an interruption to the blood supply causes bone to die. If not stopped, this process eventually causes the bone to collapse. Avascular necrosis most commonly occurs in the upper leg. Other common sites are the upper arm, knees, shoulder, and ankles.
Read the Avascular Necrosis (Osteonecrosis) article > >
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.
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