June 12, 2001 A new approach to hip replacement surgery done through a few small portals instead of a large, 12 to 18 inch incision used in traditional hip replacement surgery, dramatically reduces time in the hospital, pain and expenses. The first minimally-invasive hip relacement surgey in the world was performed in February at Rush-Presbyterian-St. Luke's Medical Center, Chicago, as part of a research study.
Because the new surgical approach involves less cutting of muscle, tendons and ligaments, patients recover more swiftly and go home the day after surgery - compared with a four to five day hospitalization for traditional hip replacement surgery.
Thus far, seven individuals whose ages range from 35 to 61 years old have had hips replaced using the new approach at Rush-Presbyterian-St. Luke's Medical Center, Chicago. The first minimally invasive hip replacement surgery in the country was done at Rush in March.
"We use a cementless prosthesis that grows into the bone, and the patients walk out of the hospital on crutches the day after the operation," said Rush orthopedic surgeon Dr. Richard Berger, who developed the new approach.
Berger is conducting a research study involving 50 patients to evaluate the effectiveness of the new surgical approach in reducing pain, bleeding and speeding up recovery time.
The initial study is limited to individuals of average weight to systematically evaluate the effectiveness of the minimally invasive surgical approach and benefits to the patients. Patients with less than ideal bone quality, who are overweight, or have excessive fat will receive the new approach after the initial 50 patients are evaluated.
The same prosthetic hip implants used in traditional hip replacements are used with the new technique. The research study solely focuses on the techniques used to access the hip, remove the damaged bone and insert the prosthesis.
Over the past year, Berger developed new ways of getting into the hip through smaller and smaller incisions, yet still allowing sufficient room to cut the bone and insert and place the components of the prosthetic hip.
The instrumentation used in hip replacement surgery was modified or redeveloped to accommodate the new approach. Bulky instruments were slimmed down to make them long and slender. New retractors, which are used in surgery to hold open the skin and muscle around the incision, were developed to allow to clearly see the hip through the small incision. A few small portals with a combined length of three to three and one-half inches are precisely located for each patient to permit removal of the damaged bone and cartilage and insertion of the new prosthesis.
After the initial minimally invasive hip surgeries, Berger reduced the operating time to one and one-half hours, less than the average time required for traditional hip replacement surgery. "The surgical technique is somewhat complicated, but you become more proficient with each operation," said Berger. "However, this is the kind of operation that probably will only be done by orthopedic surgeons who do a large number of joint replacements each year and are comfortable with learning the intricacies of the new surgical approach."
According to Berger, as people get older they do not want to give up physical activity because of joint pain caused by arthritis or other problems, and statistics show that people over the age of 80 represent the nation's fastest growing age group. "In the past, people would resign themselves to curtailing their physical activity in response to increasing joint pain that could not be alleviated by medication, " said Berger. Other orthopedic surgeons from Florida, Maryland and New Mexico are being trained at Rush on the minimally invasive hip surgery technique, and their patients will be included in the research study.
Hip replacement surgery is most commonly performed for individuals with severe, chronic pain associated with osteoarthritis that cannot be controlled through the use of various medications or physical therapy. Approximately 300,000 hip replacements are done annually, with projections for as many as 600,000 a year by 2015.
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