Less pain, quicker recovery, shorter hospital stay for hip replacement surgery

Friday, August 22, 2003

JACKSONVILLE, Fla., Aug. 22, 2003 — Hip replacement is one of the most commonly performed yet painful orthopedic procedures. However, new techniques and tools for minimally invasive surgery have significantly reduced the pain involved, the recovery time and even the necessary hospitalization to the point where some patients can go home the day after surgery.

Dr. Kurt Blasser, an orthopedic surgeon at Mayo Clinic in Jacksonville, is one of the first in the country trained to perform a new procedure to replace the hip joint through two small incisions. "This is a substantially different approach," he says. "We're not cutting as much muscle; we're just spreading the tissues to get to the hip. There's not as much pain, because we're not cutting the nerves that supply the muscle."

The two incisions are each about 1½- to 2- inches long. The surgeon generally separates the muscles, ligaments and tendons to access the hip joint. Using specially designed, lighted tools, he or she removes the damaged joint, prepares the bone surfaces and implants a prosthetic ball-and-socket joint.

Traditional surgery involves making a 10- to 12-inch long incision over the side of the hip. Cutting through tissues to get to bone is the primary cause of post-operative pain and the reason for lengthy recovery.

Almost 300,000 Americans suffering from osteoarthritis undergo hip replacement surgery each year. Many of them put off surgery because of the painful, lengthy rehabilitation typically required after standard hip replacement surgery.

Osteoarthritis damages and can eventually destroy the cartilage that lines and cushions joining bone surfaces. The head of the leg bone, called the femur, is ball shaped. It fits into the socket of the pelvic bone called the acetabulum. When the cartilage between these two surfaces erodes, everyday activities can become painful, and patients may become candidates for hip replacement.

Blasser and his colleagues at Mayo Clinic in Jacksonville perform about 400 hip replacements each year. Most of these are already done through a single, 2½- to 3-inch long incision, itself a technical advance over the standard incision.

Blasser says less pain, shorter hospital stays, and quicker recovery, rehabilitation and return to normal activities will no doubt appeal to anyone considering hip replacement. His goal is to offer the two-incision approach to everyone who is eligible.

Factors that may rule out the two-incision approach include obesity, recent history of a blood clot, prior replacement of the same hip and the shape of the acetabulum. "This would not be a good procedure for someone with a significant acetabular deformity," Blasser says. "But those patients probably represent less than 10 percent of our population."

The two-incision procedure takes 1½- to 2 hours to perform compared with 1 hour for the single, larger incision procedure. In addition to the tools to help see inside the joint, Blasser will be working to incorporate new computer-guided imaging techniques to accurately position the stem, ball and socket components of the hip prosthesis.

Most patients may be discharged from the hospital in one to two days with oral pain medication. Prostheses implanted using the two-incision approach are the same as those used with the traditional surgical approach, and they are expected to last just as long.

Additionally, Blasser is involved in developing similar minimally invasive surgery for total knee replacement that offers the same benefits in pain relief and rapid restoration of knee function.

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