• Rukmani Birla Hospital,Gopalpura Bypass Road, Near Triveni Bridge,Gopalpura,Jaipur – 302018.

MINIMALLY INVASIVE KNEE & HIP REPLACEMENT SURGERY

Since the beginning of the joint replacement surgery, surgeons have been experimenting on various techniques and methods to make the surgery more effective while at the same time less invasive. With the introduction of minimally invasive joint replacement surgery, surgeons have been able to achieve the aim and even become more advanced. Minimally invasive joint replacement surgeries involve surgeries knee and hip replacement surgery that have less trauma, reduced complications, lower risk, speedy recovery and much more. With proper techniques, it is possible to replace knee and hip by making incisions as small as 3-4 inches; though that is not the only highlight of the minimally invasive method. This process also helps to limit the damage caused to the surrounding muscles, ligaments and tendons under the skin.

Moreover, with small incision, the recovery time of the patient lowers and hence, the patient recovers and resumes normal activities faster as compared to traditional methods of knee and hip replacement surgery. Today, with advancements in medical technology – pain control techniques, surgical instruments, therapy programmes, etc. – it is possible for a person to recover from a joint replacement surgery within weeks instead of months, like in case of a traditional joint replacement surgery.

Minimally Invasive Knee Replacement Surgery

A minimally invasive knee replacement surgery is a variation to the traditional knee replacement surgery that makes a long, vertical incision in the centre of the knee to access the deceased joint and replace it with  an implant or ‘prosthesis’ to relieve pain and increase mobility. Whereas, in a minimally invasive knee replacement surgery, the surgeon makes significantly shorter incisions and uses a less invasive technique to reach the damaged or worn out joint and replacing with implants or prosthesis.

Unlike a traditional knee replacement surgery, a minimally invasive knee replacement surgery does not involve removing the soft tissues surrounding the damaged cartilage and bone. In fact, the latter is only focused on exposing the concerned joint and replacing it, while keeping all other soft tissues intact. While, the goal of both surgeries is to reduce pain, increase mobility and ensure faster return to daily activities, a minimally invasive surgery differs from a total knee replacement surgery because it is uses an incision which is almost half the length of the one made in the traditional surgery, as well as it detaches fewer muscles in comparison.

The process of both a traditional and minimally invasive knee replacement surgery is typically the same with some differences in approach. In a traditional surgery, the surgeon makes an 8-10 inch long vertical incision across the knee to access the joint; post this, the surgeon removes the damaged cartilage surfaces located at the end of the femur and tibia, as well as remove a portion of the underlying bone. Once, this is successfully done, the metal implants are put in place to recreate the surface of the knee. In some cases, the under surface of the kneecap is also removed and replaced with a plastic button.

The same procedure is followed in a minimally invasive surgery, the only difference being in the approach. In a minimally invasive knee replacement surgery, there is less cutting of the surrounding tissue and specially designed surgical instruments are used to perform the surgery to ensure minimum damage. This form of surgery is conducted via small incisions of about 4 to 6 inches and aims at causing no trauma to the quadriceps tendon and muscles in front of the thigh. This leads to less post operative pain, faster recovery, shorter hospital stay, low chances of infection, low damage to surrounding tissues and many other advantages as compared to a traditional knee replacement surgery.

However, a minimally invasive knee replacement surgery is not suited for all patients. A detailed physical assessment will be conducted to know the fit for the patient. Generally, leaner, younger healthier and more active patients are recommended for this procedure as compared to overweight, aged patients who have had previous surgeries or have complicated health issues. That said, a minimally invasive surgery also has some risks such as injury to the nerve or arteries, slow wound healing, infection, and problem in positioning of implants.

Minimally Invasive Hip Replacement Surgery

A minimally invasive hip replacement surgery differs from a traditional hip replacement surgery in terms of the approach used. In a traditional hip replacement surgery, the deceased hip joint is replaced with an implant or prosthesis that helps to improve mobility and reduce pain. This approach uses a single, long incision approximately 10-12 inch to access and replace the damaged hip joint. However, a minimally invasive hip replacement surgical procedure involves accessing the affected joint through one or two shorter incisions. In both surgeries, the damaged bone is cut and replaced along with nearby tissues; but in case of a minimally invasive hip surgery, fewer muscles around the hip are cut.

Technically, the procedure for both types of surgeries is same that involves removing the damaged femoral head and replacing it with a metal stem placed into the hollow space of the femur. This is followed by putting a ball – metal or ceramic – on the upper portion of the stem to replace the damaged femoral head. In addition, the cartilage surface of the socket that appears damaged is replaced with a metal socket and a spacer (plastic, metal or cement) is placed between new ball and socket to ensure smooth gliding.

While the procedure is the same, the difference is the technique of access – incision and the removal of surrounding tissue, which is way lesser in minimally invasive knee replacement than a traditional one. Moreover, the former procedure uses special surgical instruments to prepare the socket and femur, and fix the implants. A minimally invasive hip replacement surgery can also be of two types:

Single-incision: In this one, one incision usually about 3-6 inches is made over the outer of the hip to gain access and place the implants.

Two-incision: In this one, the surgeon makes two small incisions – one about 2-3 inches long over the groin to place the socket and one 1-2 inch long cut over the buttock to place the femoral stem. This surgery can take longer than a single incision surgery and also requires help of X-Ray and other guiding tools.

That said, a minimally invasive hip replacement surgery is not ideal in all cases. Only certain patients that the doctor seems fit in terms of weight, health, age, medical history, etc. are considered the right candidates for a minimally invasive hip replacement surgery.

In all, both minimally invasive knee and hip replacement surgeries are very effective with more advantages in comparison to traditional method, provided the patient condition is deemed fit.

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