Minimally Invasive Total Hip Replacement

What is total hip replacement?

Total hip replacement is a type of surgery to replace a damaged hip joint. A minimally invasive total hip replacement uses a smaller cut (incision) than a traditional total hip replacement. It also uses special tools.

In the normal hip joint, the rounded head of the thighbone (the femoral head) moves smoothly inside the round socket of the hipbone. The socket normally has a lining of cartilage. This helps the bones move smoothly. Moving the femoral head may cause pain as the bones scrape together abnormally when there is damage to this joint.

Your orthopedic surgeon makes an incision to access your hipbone and thighbone during minimally invasive total hip replacement. Next, the surgeon removes the damaged femoral head and replaces it with a smooth, metal stem that attaches to the rest of the thighbone. Your surgeon also removes the damaged bone and cartilage within the socket of the hipbone. This is replaced with a metal shell. Then the new femoral head can move inside the new, smooth socket of the hipbone.

Minimally invasive total hip replacement often takes place under spinal or general anesthesia.

Why might I need total hip replacement?

You might need a total hip replacement if you have significant damage to your hip joint. Different types of health conditions can damage this joint, such as:

• Osteoarthritis (most common)

• Rheumatoid arthritis

• Osteonecrosis

• Injury or break (fracture) of the hip joint

• Bone tumor in the hip joint

This damage might be painful and interfere with your daily activities. The procedure may help decrease your pain, improve your joint mobility, and improve your quality of life. Usually, healthcare providers only recommend total hip replacement if you still have significant problems after you’ve tried other, more conservative treatments, like pain medicines and assistive walking devices.

Talk with your surgeon about the benefits and risks of having a minimally invasive total hip replacement instead of a traditional procedure. A minimally invasive procedure uses a smaller incision than a traditional hip replacement. This may lead to less pain and decreased recovery time. It's not yet clear if the procedure leads to a greater risk of certain complications.

In some cases, you may have other surgical choices, like total hip resurfacing. Talk with your provider about the risks and benefits of all your choices.

What are the risks of total hip replacement?

Most people do very well with their minimally invasive total hip replacement. The procedure does carry some fairly rare risks like with any surgery. Possible complications of this surgery include:

• Infection

• Excess bleeding

• Blood clots

• Injury to nearby nerves

• Dislocation of the hip joint

• Having one leg that is a little shorter or longer than the other

• Loosening of the hip joint

There is also a slight risk that the procedure might not get rid of your pain. Or that it might leave you with new pain. Your own risk of complications may vary according to your age and your other medical conditions. Ask your provider about the risks that most apply to you.

How do I get ready for total hip replacement?

Ask your healthcare provider how you should plan to get ready for your surgery.

Tell your provider about any medicines you are taking, including:

• All prescription medicines

• Over-the-counter medicines, such as aspirin or ibuprofen

• Illegal drugs

• Herbs, vitamins, and other supplements

Ask if there are any medicines you should stop taking ahead of time, like blood thinners.

If you smoke, try to quit before your surgery.

If you are overweight, your provider may advise you to try to lose weight before your surgery.

Follow any directions you are given for not eating or drinking before surgery.

You may want to make some changes to your house to make your recovery smoother. This includes things like adding a handrail in your shower and getting an elevated toilet seat.

In some cases, your provider might want additional tests before you have your surgery. These might include:

• X-rays to get information about your hip

• MRI to get more detailed information about your hip

• Electrocardiogram (ECG) to make sure your heart rhythm is normal

Follow any other instructions from your healthcare provider.

What happens during total hip replacement?

Your surgeon can help explain the details of your particular surgery. The details of your hip replacement surgery will depend on the nature of the injury and the surgical approach. An orthopedic surgeon assisted by a team of specialized healthcare professionals will do the surgery. The whole procedure may take a few hours. In general, you can expect the following:

1. You will get general or spinal anesthesia so that you’ll sleep through the surgery and won’t feel any pain or discomfort during the procedure. (Or you may get local anesthesia and a medicine to relax you while keeping you awake.)

2. An anesthesiologist will carefully watch your vital signs, like your heart rate and blood pressure, during the surgery.

3. You may get antibiotics during and after the procedure to help prevent infection.

4. Your surgeon will make an incision over the outside of your hip, cutting through your skin and muscle. Your surgeon may make 1 or 2 small incisions.

5. Your surgeon will take your femoral head out of the hip joint socket. They will remove your femoral head and replace it with a metal or ceramic one.

6. The damaged cartilage and bone that is lining the socket is removed.

7. A metal cup is pushed into the socket and sometimes secured with screws.

8. Your surgeon will place the femoral head into the new socket.

9. The layers of skin and muscle of your incision will be closed.

What happens after total hip replacement?

Talk with your surgeon about what you can expect after your surgery. You may have significant pain around your incision after your procedure. Pain medicines may help to relieve your pain. You should be able to go back to a normal diet fairly quickly.

You may have imaging, like an X-ray, to be sure that your surgery was successful. You might be able to go home within a day or two.

Your surgeon will let you know when you can put weight on your leg. You may have specific instructions about limiting your movements. You might need to use a cane, a walker, or crutches for a few days or weeks. A physical therapist can help you maintain your range of motion and strength. You should be able to go back to most light activities within a few weeks. You may find it helpful to have some extra help at home during this time.

You might have some fluid draining from your incision. This is normal during the first few days after surgery. Let your surgeon know right away if you have increased redness, swelling, or draining from your incision, high fever, chills, or severe pain. Also let your surgeon know if your pain is not improving. Most people have an improvement in their pain after their surgery.

Make sure to keep all of your follow-up appointments with your orthopedic surgeon,. Follow all your provider’s instructions. You may need to have your stitches or staples removed a week or so after your surgery.

The mechanical parts of your hip may wear out or loosen over time. Because of this, you may need a revision surgery 10 to 20 years after your original minimally invasive total hip replacement. You may be able to extend the life of your implant by exercising regularly and taking safety measures to prevent falls.

Next steps

Before you agree to the test or procedure, make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure