ANATOMICAL CONSIDERATIONS AND EARLY CLINICAL RESULTS OF TWO INCISION MINIMALLY INVASIVE HIP SURGERY

Abstract

Minimally invasive hip replacement surgery has become the catch cry of the past 18 months. The technique of two incision surgery has been touted as allowing safe insertion of hip replacement components and early discharge of patients in comparison to standard procedures. The early results and technique developed by the author are discussed with specific reference to early complications and early radiographic and clinical results.

After extensive cadaveric dissection and anatomical study, a comparison was made of the existing exposures used in two incision surgery including pitfalls and benefits.

Following initial study, a two incision approach has been used on forty patients initially chosen as being suitable for the procedure based upon age, weight, and suitability for cementless hip replacement. Data relating to surgical time, hospital stay, post op complications and radiographic and clinical results have been prospectively analysed.

Early clinical results have been very favourable, including no increase in complication, and earlier discharge and recovery from surgery. The results are being validated by a randomised prospective international study, but the ability to discharge patients within 24 hours of surgery does not appear to be a viable option and possibly not a safe option considering the concerns relating to recovery from anaesthesia and post operative postural hypotension. A radiographic assessment has revealed accurate placement of implants compared to an historic group using conventional exposure.

Clinical scores have been better at six weeks and three months compared to mini incision and standard incision patients.

Further research and experience is required for this technique to be fully applicable and available to the general orthopaedic population. Technically the procedure is more challenging and does require adequate instruction and does have a significant learning curve. However, the early clinical results do support earlier discharge and more rapid recovery compared to standard hip replacement surgery.