Less invasive philosophy in joint replacement surgery |
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Orthopaedic surgeons have always been experimenting with less traumatising joint replacement procedures. Recently, however, “… there has been a renewed interest by both patients and surgeons in so-called minimally invasive and small incision surgery...” (AAHKS). |
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I was introduced to a limited approach in joint replacement surgery by my teachers about 10 years ago. To me it appeared common sense that less invasive operative methods can provide benefits to patients. I have finally chosen, what I think is the safest and least invasive approach to hip joint replacement surgery. I would confidently call it less invasive surgery in comparison to conventional techniques. movie (wmv) |
Less invasive surgery is a terminology that includes a small skin incision and minimally invasive deep soft tissue and bone exposure. Minimally invasive and small incision techniques are difficult to evaluate. Incision length has not been, until recently, a major focus of concern. There is also no defined way to measure incision length or soft tissue damage that occurs with surgery. The relative importance of any given anatomic structure's integrity, detachment or excision is hard to know. A distinction between contemporary and less invasive approaches is therefore difficult to establish. Less invasive surgery may include unique pre-and post-operative pathways for anaesthesia, nursing care and rehabilitation. With regards to patient selection criteria I believe that less invasive surgical techniques can be offered to almost all patients - as long as individual anatomical variations are taken into consideration. Less invasive surgical implants utilise small components. It has to be stressed, that most of these implants have originally been designed for conventional approaches. Acknowledging that there are contradictions published in the literature on less invasive arthroplasty techniques, I am convinced that there are advantages. Recent publications have shown that less invasive total hip arthroplasty performed by a high-volume hip surgeon with extensive experience is safe and reproducible. I learned from personal experience that less invasive surgery preserves tissue intervals, leaves a smaller scar, minimises muscle and bone damage. I am not sure if less invasive techniques decrease immediate post-operative pain which in my opinion should be mainly controlled by appropriate anaesthetic technique. Potential disadvantages of less invasive joint replacement surgery have been reported and relate to the difficulty of performing surgery within a restricted visual field. Such complications may include fracture, malposition of the implant and neurovascular injury. These complications are by no means limited to less invasive techniques. Less invasive surgery is demanding. It is a general philosophy which should be considered by every surgeon. This involves - as with all surgical procedures - critical evaluation of individual patient anatomy, of implants and instruments. Expectations surrounding “keyhole” surgery (arthroscopy like) are unrealistic. Less invasive techniques can be applied for any surgical approach. Use of computer assistance (navigation) in combination with less invasive techniques might improve implant alignment and long term outcome in joint replacement surgery. This article includes excerpts from statements published by the National Institute of Clinical Excellence, the British Orthopaedic Association and the American Association of Hip and Knee Surgeons (AAHKS), JBJS April 2005 Vol.87-A No.4, as well as the author's personal opinion. The above statement is my personal opinion provided for my patients and intends to prevent disappointment as well as create positive forward thinking in everybody who is planning to undergo modern joint replacement surgery. |
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