Minimally Invasive Surgery Provides Quicker Recovery Times and Fewer Complications
Hip replacement surgery is not what it used to be. A minimally invasive approach incorporating additional medical advancements is now a viable option for a younger population suffering from a variety of hip problems. The highly specialized orthopedic surgeons at Emory Orthopaedics & Spine Center have helped thousands of young patients quickly regain long-term functionality, mobility and quality of life with less risk and fewer complications than ever before. In addition over 80 % of patients are discharged the same day of surgery.
Case History
A 39-year-old female and former Olympian was referred to Emory Orthopaedics & Spine Center for persistent, progressive groin pain. It started as a tightness and ache after vigorous training sessions when she was a teenager. The pain was easy to ignore at the time, but over the years it gradually became more noticeable. Eventually, the inescapable ache interfered with her active lifestyle so much that she was unable to walk very far or stand for long periods.
The patient tried physical therapy, which didn’t help much. Acetaminophen was ineffective, and she developed stomach ulcers from taking large doses of Advil. She had found relief with pain medications but became dependent on them to function from day to day.
Diagnoses & Treatment
X-rays revealed the patient had hip dysplasia with early onset arthritis; there was a total loss of cartilage in the joint. Despite the patient’s young age, the Emory orthopaedic surgeon recommended a minimally invasive, anterior-based hip replacement in which the hip joint is approached through the muscle interval between the tensor fascia lata and the gluteal muscles. Medical advancements over the last decade have made this outpatient procedure safe and highly effective for patients of any age.
The patient was walking with crutches immediately after surgery. In approximately ten days, she switched to a cane for support and was walking without any assistive device after approximately two and a half weeks.
The patient did not need physical therapy but was given an at-home instruction program to rebuild muscle strength. At her three-month checkup, she was cleared to resume an active lifestyle without restrictions. The surgeon recommended periodic checkups (every five years) to ensure the X-rays look good and all continues to function well. No additional surgeries are expected at any time throughout the patient’s life.
Advancements in Hip Replacement Surgery at Emory
The specialized surgeons at Emory Orthopaedics & Spine Center were the first in the Southeast to begin performing anterior-based hip replacements. They have been innovating this technique since 2009 and have completed more than 5,000 surgeries, which have returned long-term functionality in older patients as well as young patients with higher levels of demand.
By incorporating other major advancements in anesthesia, implants and surgical equipment, the surgeons at Emory have helped younger hip replacement patients recover quicker and experience fewer complications than they would have with older techniques.
-
Anesthesia
Quick acting, ultra-short spinals are now being used during hip surgery. The technique allows pain-free surgery and quick return to function by eliminating cognitive disturbance and nausea associated with traditional general anesthetic techniques. Because of this, patients can actually start walking while in recovery. The ultra-short spinal also drops blood pressure to a low and safe level, which means patients lose much less blood than they may have with more general anesthesia techniques. Nowadays, transfusion rates after these surgeries are less than 1-2%.
-
Implants
The bearing of a hip replacement allows pain-free motion in the joint after surgery. Because it supports heavy loads (2-3 times body) and is exposed to a high cyclical demand, it must be durable. In the late 1990s, manufacturers started using modified polyethylene to create the bearing surface. The wear rates on these have been outstanding. Performance data shows the wear rate on twenty-year-old implants has been reduced so much that it cannot be measured on X-rays. If they continue to perform at this level over time, there is no way the implants will wear out over the course of a patient’s lifetime. However, ongoing study is needed to ensure the wear rate remains low after twenty years.
Another crucial advancement is the availability of a highly porous metal coating on the outer aspect of the implants. Usually made of titanium, the body recognizes the coral-like architecture as bone and will create a living bond with it by growing into the porous network. Because the bond is living and dynamic, it has the potential to endure the stresses placed on the joint for the remainder of the patient’s life.
-
Specially Designed Surgical Equipment
The surgical equipment used during anterior-based hip surgery is specially designed for the procedure. The operating table has spars on it so the hips can be positioned in ways that are not possible with regular tables. This allows the surgeon to create angles that expose the natural interval in the joint. Then, using instruments sized specifically to fit the interval, the surgeon can perform the surgery without cutting or detaching a single muscle fiber.
Fluoroscopy helps the surgeon place the implant in the ideal position during the surgery and helps confirm that leg lengths are equal. Better alignment leads to stability and performance over time.
The wound is closed with absorbable sutures below the skin level and sealed with a waterproof dressing that reduces the risk of environmental contaminants causing an infection. There is no wound care after surgery. The patient is able to shower right away, and the seal is removed when the skin has healed (usually two weeks later).
Pre-op X-ray of arthritis in left hip (on right side of image)
Post-op after bone has grown to implant
Microscopic image of porous titanium on implants that allows bone to bond to implant
Who to Refer
It can be difficult to read the subtle signs on an X-ray that signify hip dysplasia, arthritis or other joint problems. An MRI may be needed to see the narrowing of the joint space more clearly. Therefore, symptoms should be the number one trigger for referring a patient to an orthopedic specialist. Any patient complaining of persistent, progressive groin pain over time should be referred. Even if surgery is not needed, other specialized treatments may help patients find relief.
To refer a patient with persistent, progressive groin pain to the Emory Orthopaedics & Spine Center, call 404-778-3350. A representative from Emory Healthcare will help schedule an appointment.
Emory Orthopaedics & Spine Center is committed is committed to the continued health and safety of all patients. During this time, we are taking all necessary precautions to screen for coronavirus (COVID-19) and to prevent its potential spread. We continue to monitor the evolving COVID-19 pandemic and are working with experts throughout Emory Healthcare to keep your patients safe. For the most up-to date information for our referring partners, click here.