Hip Replacement Surgery: The Good, The Bad, And The Ugly

In the last ten years, huge gains have been made in using “minimally invasive surgery” (MIS) for hip replacements. Those patients, who qualify for this type of surgery, no longer have to endure the pain from “open” surgeries where the orthopaedic surgeon had to make large incisions, up to six inches long.

MIS has fewer complications in a number of ways. Patients can recover much faster with only one small surgical scar about two inches in length. In 2003, 217,000 total hip replacements were done. Doctors, trained in this procedure, estimate that only 17 to 20% of their patients are candidates for MIS.There is a high demand from patients for “minimally invasive” surgery. According to a study done by the Mayo Clinic, MIS is not free of complications. This type of surgery takes more time than the conventional surgery, requiring more anesthesia. It also can cause more muscle damage than the traditional “open” surgery. Other studies have shown “sub-optimal positioning of the knee implants” and virtually no difference in recovery time.John J. Callaghan, MD, Professor of the Departments of Orthopaedic Surgery and Biomedical Engineering at the University of Iowa College of Medicine and spokesperson for the American Academy of Orthopaedic Surgeons, is concerned about the number of surgical “revisions” — MIS procedures that have to be redone due to problems with the first surgery. “At the present time,” Callaghan says, “we have many more revisions than Sweden.” There are several reasons for this. The visual field is more restricted. “When doing MIS, the surgeon is working with inserting devices through a very small incision. It is critical that s/he make sure the components are in the right position,” explains Dr. Callaghan.Another complicating factor is the size of some of the patients. Obesity is a growing problem in the United States. Obese patients are not good candidates for hip replacement surgery. John Callaghan, MD, has a word of caution, “It is very important that we have the good surgical candidates with correct fixation of the parts in hip replacement surgery. I do not want to see this procedure go ‘backwards’.” In the final analysis, orthopaedic surgeons consider long-term durability of the hip replacement more important than the length of the patient’s hospital stay.(Source: Annual Meeting of the American Academy of Orthopaedic Surgeons : University of Iowa College of Medicine : March 2007.)