Is it time for a hip replacement?
Doesn’t it seem like the minute you get one thing fixed or replaced, something else breaks down? Cars, computers, appliances… even our hips and knees! That’s because they too are subject to “wear and tear” over time, contributing to the development of joint issues like osteoarthritis which causes pain, stiffness and decreased mobility.
When painkillers, physiotherapy and other treatments aren’t enough to ease the suffering, doctors may recommend “arthroplasty,” surgery to remove some or all of the damaged joint and replace it with an artificial (metal and/or plastic) joint. It’s an increasingly common procedure: over the last 5 years the number of hip replacement surgeries has increased by nearly 20% in Canada (1).
Standard hip replacement surgery is a "posterior" approach, requiring an incision – usually 10 cm or longer – along the side to the back of the hip in order to get at the joint. In recent years, there’s been a focus on less invasive techniques, such as making ‘mini-incisions’ (less than 10cm in length) to replace the joint. The theory is that by cutting into less tissue and muscle, there is less damage and blood loss, which in turn results in faster recovery (2). However some claim that the modified procedure increases the risk of complications such as hip dislocation and nerve injury (3).
The results of a systematic review of 16 studies, including 12 high quality randomized controlled trials , help to inform the debate (4). More than 1,400 participants over the age of 60 had posterior hip replacement surgery using either the standard approach or smaller incisions. They were compared in terms of operating time, loss of blood during surgery, length of hospital stay and presence of joint dislocation. They also underwent tests that measure characteristics like pain, stiffness and function.
What the research tells us
Mini-incision surgery for hip replacement appears to have some advantages including shorter time in the operation room, less blood loss during surgery, and a shorter hospital stay (an average of half a day) (4). There was no significant difference in complications between the two types of surgery, including hip dislocations, infections, nerve injuries and blood clots (4).
According to Dr. Anthony Adili – Chief of Surgery at St. Joseph’s Healthcare in Hamilton, Ontario and an expert in hip and knee replacement – there is a bit more to the story. In his experience, the position of the implant and the amount of trauma to the surrounding tissues have the greatest impact on a patient's recovery after hip replacement. Because of this, the type of approach (these studies focused only on posterior surgery), the skill of the surgeon and the characteristics of individual patients are all important factors to consider when deciding whether mini-incision surgery is best for you.
On the other hand, he says, surgical approaches have improved since these studies were conducted and impacts on recovery – such as length of hospital stay – may be better than those reported. Also, “another benefit of mini-incision surgery is cosmetic,” points out Dr. Adili, and a less-noticeable scar may be important to many people.
So if your surgeon thinks mini–incision hip replacement surgery is right for you, you can be relieved to know that it is not likely to put you at any greater risk, and may even get you back to doing the “hippy hippy shake” a little sooner!