Over time three separate minimally invasive surgery hipreplacement techniques have developed. Each of these are "new" and experience is evolving with their use.
1. The small incision hip.
2. The two incision hip with x-ray control.
3. The single anterior incision hip.
The small incision hip:
This was the first attempt at the MIS hip. The techniques used were much like
in the conventional hipreplacement operation, but carried out through smaller
cuts in the skin and so involved less muscle cutting. With time and experience
the skin and muscle cuts used became progressively smaller.
The two incision hip:
About 3 years ago, another new technique of performing the surgery was devised.
This involved two incisions and the procedure came to be known as the "Two
Incision Hip" . This was a radically different approach. The operation
was carried out on a "x-ray friendly" table and required the use of
x-rays during the procedure. A 5-6 cm cut was made in the groin area. The muscles
were separated to access the hip joint and the artificial socket placed under
x-ray visualisation. The use of x-rays was necessary as the surgeon was not
able to see the natural socket cavity and had to depend upon x-rays to place
the components properly. The femoral component was inserted through a second
cut made on the side of the hip and also measured about 5-6 cm. The muscle fibres
were then separated to insert an "opener" instrument into the thigh
bone (femur) followed by the stem component of the hip joint.
The patient experience after the two incision hip appeared to be better than that achieved with the conventional approach using the smaller incision (the small incision hip). Some younger and fitter patients were able to go up and down stairs with 8-10 hours of the surgery. With experience and as the surgeons became better at the technique, patients were well enough to be discharged from hospital at about 24 hours after the operation. As with any new technique, there was a substantial learning curve for all involved. The time taken for the surgery and the complication rate was higher than with the conventional technique. With time, improvements in both of these aspects have come about.
The single anterior incision:
This is the newest technique of MIS hipreplacement surgery. It was developed
in the middle of 2003 by a German doctor. This technique is based on a well
known and previously described surgical approach though the originator has made
a number of modifications to minimise the muscle damage during hipreplacement
surgery. It involves a single anterior incision about 9 or 10 cm long. No muscle
cutting is required and the socket and the stem can be implanted without the
need for x-rays. A special table is required to permit optimum positioning of
the leg to aid exposure. From the patient's perspective, the outcome appears
to be similar as for the two incision hip.
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