Hip Replacement

Types

Total hip replacement can involve many different techniques, and each surgery has pros and cons. The procedure chosen for a patient depends on the patient's needs and his or her medical history.

Conventional Hip Replacement Surgery

Standard hip replacement surgery includes incisions customized to the patient's physical size (overweight and obese patients usually require longer incisions). Some muscles around the hip are detached to expose the joint while the prosthesis is placed. Conventional hip replacement has evolved. What is considered conventional today was not regarded as conventional even five years ago. Improved techniques have made recovery from conventional hip replacement somewhat faster and skin incisions shorter.

One-Incision "Mini Hip"

The one-incision "mini hip" uses traditional surgical techniques and prostheses but reduces the surgical incision from 8-10 inches to about 4-5 inches. "Mini" refers to the size of the incision, not the size of the prosthesis. Some orthopedic surgeons use the "mini-hip" technique to place the conservative hip, a joint developed at Mayo Clinic that requires removal of less bone than conventional prostheses.

The single incision can be made in the front or back of the hip. As with traditional surgery, the procedure requires releasing (detaching) some muscles around the hip to reach the joint. Approaching from the front usually involves releasing some abductor muscles (the large muscles that pull the leg out to the side). Approaching from the back usually involves releasing some external rotator muscles. At the end of the operation, the muscles are reattached.

Two-Incision Surgery

This surgery involves making two incisions, each 2 to 2.5 inches long. One incision is mde in the front of the hip to place the socket (acetabular) component of the prosthesis, and the other incision is made in back to place the ball (femoral) component. Although this procedure allows surgeons to navigate between and around muscles, tendons and soft tissues (instead of cutting through them), some patients have experienced muscle damage. This procedure has a higher risk of complications, so not everyone is a good candidate.

Mayo Conservative Hip

Developed by Bernard Morrey, M.D., an orthopedic surgeon at Mayo Clinic in Rochester, the conservative hip is a "short stem" prosthesis, 4 inches long compared to 6 to 8 inches for conventional prostheses. It is called conservative because it conserves more of the patient's thigh bone (femur) than other prostheses.

The procedure involves a single, 3-inch incision at the front of the hip. Although some abductor muscles are released (detached), a study of 146 Mayo Clinic patients showed the prosthesis was still stable five and 10 years after the procedure.

The Mayo hip requires no cement. Instead, the titanium-aluminum-vanadium implant is wedged into the top of the femur's central shaft, and bone grows into the implant's porous surfaces. Because relatively small amounts of bone are removed, surgery and anesthesia times are shortened, blood loss is reduced and recovery tends to be faster.

Advantages of Minimally Invasive Surgery

Minimally invasive surgical techniques are used with pain management strategies developed by Mayo Clinic anesthesiologists that do not require the use of large doses of opioid medications. Together, they offer several advantages:

• Many patients leave the hospital in two or three days versus five to six, and return to work and daily activities sooner
• Less trauma to the body
• Less need for pain medication
• Less blood loss during surgery
• Less need for a blood transfusion and presurgery blood donation
• Smaller surgical scar

Hip Resurfacing

Mayo Clinic surgeons also perform hip resurfacing, a technique in which only the worn surfaces of the hip joint are covered. Resurfacing is a type of hip replacement that has some potential advantages and disadvantages over standard hip replacement. Hip resurfacing typically requires removal of less bone than hip replacement. Resurfacing is appropriate for younger, physically active patients, with good bone stock, and without major leg length or femoral head abnormalities. Hip resurfacing is offered in Florida and Minnesota.

Recovery after Hip Replacement

Following surgery, patients stay in the hospital for a few days and begin physical therapy to strengthen hip muscles and increase mobility. Depending on the progress made at the hospital, patients may require additional physical therapy after returning home. Within four weeks, most patients feel better, and within eight weeks, they may begin incorporating normal activities into their routine. After this recovery period and under physician guidance, patients are usually able to recover fully within a few months.