Mini-Total Hip Replacement
Hip replacement surgery is performed about 300,000 times in the United States every year. Because of the long history of hip replacement surgery, this procedure has become a safer and more reliable method to treat severe hip arthritis pain.
The hip joint is subject to tremendous forces even with normal walking as we simply walk at a normal pace. The combination of the weight of the body and muscle forces applied to the hip, add up to approximately three times the body weight. If the hip joint does not develop properly, if it has been subjected to injury or simply a wearing out process that occurs as we age, the hip may become arthritic and painful.
The arthritic or damaged hip causes pain in the groin with radiation down the side, making it difficult to put on shoes and socks and can cause pain with extended walking and difficulty getting up out of a chair.
The patient can sometimes manage the discomfort with the use of anti-inflammatory medication (ibuprofen), use of a cane in the opposite hand or simply restricting their amount of activity. People give up their routine walk, they restrict their shopping and avoid activities that would other-wise be normal for them.
What’s involved with a Total Hip Replacement?
The surgery involves removing the diseased or worn out joint and replacing it with a plastic or metal joint. The traditional surgery involves a nine to twelve inch incision through the skin, muscle and fascia. The discomfort actually comes from the injury to the soft tissue. Once in place, the joint becomes quite comfortable immediately after-surgery.
The mini-incision hip replacement, the Dr. Hoffman performs, involves performing the same procedure as the traditional approach, only using a 2 to 3 inch incision-this requires special instruments, an experienced surgeon and special training in the use of the instruments. The first such surgery in the Quad-City area was done in April of 2001.
The 2 ½ inch incision dramatically reduces the amount of injury to the soft tissue. There is much less blood loss and transfusion is required only infrequently. The patient typically stays in the hospital two days post surgery instead of the usual four to five days. The occasional patient may even leave the hospital the day following the surgery. Patients are also pleased with the size and location of the scar.
Surgeons used to believe that the size of the incision made very little difference in the patient’s post operative course. We now know that is certainly not the case. Much of the pain from the surgical procedure actually comes from the skin incision and the injury to the underlying muscle and fascia. Knee arthroscopy has been so successful for such a long period, most people don’t recall the amount of pain and disability that resulted from the 2 to 3 inch incision necessary to remove the torn cartilage from the knee prior to the development of the knee arthroscopy in the late 1970s.
Most often patients arrive the morning of surgery. The actual surgery time takes approximately 45 minutes to remove and insert the artificial hip joint and then another 15 minutes to close the wound. Due to the prep and post op time involved, the total time in the operating room is approximately, 2 hours. Spinal anesthesia sedation is the typical option used, but sometimes general anesthesia may be required. The advantage with the spinal option is that morphine can be placed into the spinal fluid which results in significantly less post operative pain.
Patients are encouraged to get up and moving right away. Once the patient is able to stand up and walk from the bedside to the bathroom and back, with assistance from a nurse or physical therapist, then the formal therapy process begins. This typically takes place within hours of the completion of the surgery.
Many patients are able to have the procedure performed at the Mississippi Valley Surgery Center on an outpatient basis and are able to go home within 24 hours of the procedure with no hospital stay required. When performed at a hospital, the typical patient is admitted as a 23 hour hold, which typically gets the patient back home within 1 day following surgery, not the typical 2-3 days that the traditional approach requires.
How long is the recovery period after surgery?
Total hip replacement surgery is an extremely effective and successful way of relieving the discomfort and allowing people to return to normal activity. It is not uncommon to allow people to return to walking several miles per day. Pain relief can be quite dramatic.
Patients are typically walking 200 ft and doing some stairs the 1st post operative day and are typically using a walker for 3-7 days and a cane for 1-4 weeks following surgery. Although not typical with every patient, some patients are walking up to a mile one month after the surgery. It is common to have residual swelling and pain two months post operatively or night time discomfort. This should improve over the course of a few months following surgery.
