Minimally Invasive Hip Surgery Introduction

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  • Source “ MIH Replacement: New Techniques for Total Hip replacement may help reduce recovery time” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.mih.com Notes People suffering from arthritis of the hip must alter their daily activities to deal with pain. Many people find relief in medicines, exercises, and weight-management programs. However, many patients have intense pain that keeps them from enjoying life. Doctors may discuss hip replacement surgery with patients who do not get relief from other treatments. Surgeons have been performing this procedure for decades.
  • Source “ Mini-Incision or Two Incision: What is the Difference?” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.mih.com Notes In traditional total hip replacement surgery, surgeons cut a 12- to 18-inch incision through the soft tissue of the leg and hip. While traditional hip replacement surgery has been successful, recovery times can be long. During the past two decades, minimally invasive approaches to surgery have transformed a number of surgical specialties, including general surgery and, to a lesser degree, cardiac surgery. Minimally Invasive hip surgery is an advancement in total hip replacement techniques because the procedure can be done with less invasive techniques.
  • Source “ Frequently Asked Questions About Minimally Invasive Hip Replacement Surgery” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.mih.com Notes Minimally invasive hip replacement surgery involves the use of smaller incisions to replace the worn out hip with an implant. Some doctors refer to this surgery as either “minimally invasive” or “minimal incision.” Both terms refer to the same technique. There are several types of minimally invasive hip surgery techniques, including the single-incision and the direct two-incision techniques.
  • Source “ Frequently Asked Questions About Minimally Invasive Hip Replacement Surgery” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.mih.com Notes What is the difference between traditional hip replacement surgery and minimally invasive hip replacement surgery? TRADITIONAL HIP REPLACEMENT SURGERY ·         Proven in clinical studies. ·         Successfully performed for decades. ·         Allows surgeon full visualization of operative area. ·         Requires a larger incision, which can lead to more disruption of muscles and tissues. MINIMALLY INVASIVE HIP SURGERY ·         Requires smaller incisions, which may lead to a decreased disruption of muscles and tissues. ·         May lead to less blood loss during surgery and less postoperative pain.
  • Source “ Frequently Asked Questions About Minimally Invasive Hip Replacement Surgery” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.mih.com Notes What is the difference between traditional hip replacement surgery and minimally invasive hip replacement surgery? TRADITIONAL HIP REPLACEMENT SURGERY ·         Average hospital stay is five days. ·         Average recovery time of approximately three months (individuals will vary). ·         Leaves a large scar on the patient’s thigh.   MINIMALLY INVASIVE HIP SURGERY ·         May lead to a shortened hospital stay after the surgery. ·         May reduce recovery time. ·         Scars will be smaller and less noticeable. ·         Long-term effects and success are being studied.
  • Source “ Minimally Invasive Hip Replacement: New Techniques for Total Hip Replacement May Help Reduce Recovery Time” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.mih.com Notes MIH surgery uses the same implants as traditional hip replacement surgery. However, at this point some minimally invasive approaches may limit the implant options available to the surgeon. Because the surgery is done through smaller openings, refined instrumentation has been developed to help surgeons navigate in the smaller opening. Thus surgeons are able to utilize implants, while incorporating these new and innovative techniques.
  • Source “ Frequently Asked Questions About Minimally Invasive Hip Replacement Surgery” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.mih.com Notes Patients suffering from hip arthritis who have failed to respond to medicines, exercises, weight-management programs and other therapies are potential candidates for minimally invasive hip replacement surgery. Some doctors recommend that patients be close to their ideal body weight. Others say this is not crucial. Source “ Small-Incision Approach to Hip Replacement Surgery ” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.mih.com Notes The decision to undergo small-incision surgery is ultimately yours, but factors your surgeon will consider include medical history, weight, general health, and body structure including bone structure, and extent and pattern of arthritis. Patients who are severely obese, very muscular and those undergoing complex revision surgeries may not be appropriate candidates for this technique. [1] [1] Kathleen Ogle, “Joint Reconstruction,” Orthopedics Today.
  • Source “ Small-Incision Approach to Hip Replacement Surgery ” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.mih.com Notes The decision to undergo small-incision surgery is ultimately yours, but factors your surgeon will consider include medical history, weight, general health, and body structure including bone structure, and extent and pattern of arthritis. Patients who are severely obese, very muscular and those undergoing complex revision surgeries may not be appropriate candidates for this technique. [1] [1] Kathleen Ogle, “Joint Reconstruction,” Orthopedics Today.
  • Source “ Frequently Asked Questions About Minimally Invasive Hip Replacement Surgery” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.mih.com Notes Minimally invasive hip replacement surgery involves the use of smaller incisions to replace the worn out hip with an implant. Some doctors refer to this surgery as either “minimally invasive” or “minimal incision.” Both terms refer to the same technique. There are several types of minimally invasive hip surgery techniques, including the single-incision and the direct two-incision techniques. SINGLE-INCISION Image of incision sites This technique involves one incision on the thigh. The size of the incision is generally 3 to 4 inches. Two basic types of single-incisions include: ·         Anterior- incision is made on the front of the thigh. ·         Posterior- incision is made on the back of the thigh. TWO-INCISION: Direct or Using Fluoroscopy Image of incision sites. This two-incision technique makes an opening of approximately 2 inches on both the front and rear of the thigh. The surgeon can clearly see what he or she is doing through these openings without the need for X-ray radiation
  • Source “ The Two-Incision Approach” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.mih.com Notes With the two-incision approach, which takes anywhere from 80 minutes to two hours, patients lie on their side with their back to the doctor. Working in such a small area, the surgeon’s field of vision is obviously narrowed. To overcome this drawback, he or she may use fluoroscopic technology. These real-time X-ray images are displayed on a television monitor located in the operating room. Source “ DePuy Small-Incision Minimally Invasive Hip Replacement Surgery” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.mih.com Notes The mini-incision is usually three to four inches long, compared to the traditional 12-inch to 18-inch opening. Because surgeons don’t cut as much skin, muscle, tendons and ligaments patients can potentially recover quicker. The mini-incision technique can be performed through either the anterolateral (front of the hip) or posterolateral (back side of hip) approach. In both techniques the patient is laying on his/her side. The approach selected is based on surgeon training.
  • Source “ Hip Replacement Surgery”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.allaboutarthritis.com Notes The Surgery Your hip joint is made up of two parts, the socket, in your hip or pelvic bone and the ball, at the top of your upper leg bone (femur). Your surgeon will make an incision on the side of your thigh and will re-shape the socket to fit the new cup implant that replaces your diseased socket. After the socket is re-shaped, a new cup will be placed in the socket. The cup usually consists of a metal shell and a polyethylene liner.
  • Source “ Hip Replacement Surgery”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.allaboutarthritis.com Notes Your surgeon then prepares your femur for the femoral stem, which will hold the new ball part of your hip joint. The head of your femur is removed and the bone is prepared for the new femoral stem. Your surgeon will most likely use a trial implant to verify the correct fit. After your permanent hip stem is implanted, the ball that sits at the top of the femoral stem will be put into place. Once your surgeon is satisfied with the position and movement of your new hip joint, it will be flushed with cleansing fluid and closed with surgical staples.
  • Source “ Small Incision or Two-Incision: What is the Difference?” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.mih.com Notes Because the small incisions cause less trauma to the body, healing and rehabilitation can potentially begin sooner. Patients begin rehabilitation immediately and hospital stays are kept to a minimum some patients are able to leave the same day surgery is performed . The lack of cutting through lateral (side) and posterior (back) soft tissues also allows for immediate stability of the hip ,potentially lower risk of dislocation and potentially less postoperative pain.
  • Source “ Hospital Stay and Rehabilitation After Minimally Invasive Hip Replacement Surgery” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.mih.com Notes Patients having MIH surgery can prepare for the recovery process before surgery. Because the rest of the body must compensate for the healing hip, strength conditioning before surgery enhances recovery. Using crutches can be made easier by strengthening the upper body, as well as the opposite leg, prior to surgery. A visit with a physical therapist before the MIH operation may be helpful. The physical therapist will: ·         Let the patient know what to expect in the hospital. ·         Teach the patient how to protect the hip after surgery. ·         Answer questions about rehabilitation.
  • Source “ DePuy Small-Incision Minimally Invasive Hip Replacement Surgery” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.mih.com Notes Before you are admitted to the hospital, you will be given a medical evaluation by your physician, which will include an X-Ray of your hip. Source “ Preparing Your Mind Before Joint Replacement Surgery ”. DePuy Orthopaedics, Inc. 2 April, 2003. http://www.jointreplacement.com Notes Another helpful tool is simply learning more about what to expect before and after joint replacement surgery. For example, one study (Psychosomatic Medicine, 2000) by Austrian researchers involved 100 people who were about to undergo hip replacement surgery. The night before their hip replacement, half were shown a short videotape depicting the surgery experience from a patient's perspective. Compared to those who didn't watch the tape, these joint replacement patients reported feeling less anxious both right before and right after their operation. They also had lower levels of Cortisol, a stress hormone, in their urine, and they were less likely to have an excessive rise in blood pressure during surgery. In addition, they needed less pain medication during recovery.
  • Source “ Hospital Stay and Rehabilitation After Minimally Invasive Hip Replacement Surgery” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.mih.com Notes The physical therapist will see the MIH patient the day of surgery or the next day in the hospital. The physical therapist will assess the patient’s: Range of motion. Ability to move in bed. Breathing. Ability to bear weight. The physical therapist will show the patient how to safely execute everyday tasks. These include getting in and out of a chair, using the toilet and bathing. The therapist will discuss the best sleeping positions to protect the hip from dislocating.
  • Source “ Hospital Stay and Rehabilitation After Minimally Invasive Hip Replacement Surgery” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.mih.com Notes Patient should be able to accomplish certain activities before leaving the hospital. These include: ·         Walking 100 feet with the help of a walker. ·         Knowing how to climb stairs safely. ·         Being able to do exercises independently. ·         Being equipped with assistive devices such as a sock tool, wedge pillow, and a raised toilet seat.
  • Source “ Hospital Stay and Rehabilitation After Minimally Invasive Hip Replacement Surgery” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.mih.com Notes The healing hip has a limited range of safe motion. For about three months patients should follow safety rules called “hip precautions.” The hip precautions discourage patients from crossing their legs and bending in ways that put too much stress on the hip. Following these rules helps protect the hip as it heals. Patients can resume low-stress activities at their doctor’s direction. These may include walking, stationary skiing, swimming, biking, and exercises that have a low impact on the hip. Hip patients should avoid high-impact and contact sports. While some patients may feel good after minimally invasive hip replacement surgery, it is important they follow their doctor’s instructions to ensure a complete recovery.
  • Source “ Potential Complications Associated with Minimally Invasive Hip Surgery” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.mih.com Notes Some of the factors that may affect the rate of complications with hip replacement surgery include: The skill of the surgeon. The weight, age, and overall health of the patient. The lifestyle and activities of the patient. The presence of osteoporosis or other conditions that weaken a patient’s bones. How well the patient complies with instructions from doctors and therapists.  
  • Source “ Potential Complications Associated with Minimally Invasive Hip Surgery” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.mih.com Notes Hematoma Hematoma is similar to bruising. It occurs when blood enters the surgical wound after surgery. If the bleeding becomes excessive, the wound may need to be drained. There is no evidence that the risk of hematoma is any different with either minimally invasive or traditional hip surgery. Fracture In some cases, inserting the new hip stem of the implant can fracture the thigh bone. This can occur if the bone is already weak due to osteoporosis or other diseases. Surgical devices can correct this problem should it occur. Fracturing during surgery has not been shown to be any more likely for MIH or traditional surgery. A fracture can also occur after surgery. Falling or failing to follow the precautions given by the physical therapist may lead to a fracture. If the implant becomes loose because the bone gets fractured, the surgeon may have to operate again to fix the problem.
  • Source “ Potential Complications Associated with Minimally Invasive Hip Surgery” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.mih.com Notes Infection Infections after surgery can be very serious. However, the chance of getting an infection after hip replacement surgery is about 1 percent. Infections can show up before the patient leaves the hospital. However, some do not become evident for months or years after the operation. Infection can spread to the artificial joint from other areas of the body . Dislocation Dislocation of the hip implant can occur when the ball of the hip comes out of the socket . Deep Venous Thrombosis Deep Venous Thrombosis (DVT) is most common after surgery on the hip, pelvis, or knee. DVT occurs when the blood in the large veins of the leg forms clots. This may cause the leg to swell and become warm and painful. If the blood clots break apart, they can travel to the lung. This can cut off the blood supply to a portion of the lung.
  • Source “ Hospital Stay and Rehabilitation After Minimally Invasive Hip Replacement Surgery” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.mih.com Notes It is too early in the evolution of minimally invasive hip surgery to be able to forecast the long-range rehabilitation process of the patient. Each patient will have a unique rehabilitation process based on his or her health and level of activity before the surgery. Clinical evidence is being collected to see how much minimally invasive hip surgery enhances rehabilitation. Patients should keep in mind that the main criteria for hip replacement surgery should always be patient comfort and the best long-range outcome.
  • Minimally Invasive Hip Surgery Introduction

    1. 1. Minimally Invasive Hip Surgery
    2. 2. Introduction <ul><li>Many people suffering from arthritis alter their lives to deal with pain. </li></ul><ul><li>If you haven’t found relief in medicines, exercises, and weight-management, hip replacement surgery may be a solution. </li></ul>
    3. 3. Background on Minimally Invasive Surgery <ul><li>A significant advancement in total hip replacement </li></ul><ul><li>MIS is not new </li></ul><ul><ul><li>Performed on knees </li></ul></ul><ul><ul><li>Cardiac patients </li></ul></ul>
    4. 4. What is Minimally Invasive Hip Surgery? <ul><li>New surgical technique. </li></ul><ul><li>Uses traditional hip implant components. </li></ul><ul><li>Different techniques, including mini-incision and two-incision. </li></ul>
    5. 5. Difference Between Traditional and Minimally Invasive Hip Replacement Surgery <ul><li>Traditional Hip Replacement Surgery </li></ul><ul><ul><li>Proven in clinical studies and successfully performed for decades </li></ul></ul><ul><ul><li>Allows surgeon full visualization of operative area </li></ul></ul><ul><ul><li>Larger incision (12-18 inches) </li></ul></ul><ul><ul><li>More disruption of muscles and tissues </li></ul></ul><ul><li>Minimally Invasive Hip Replacement Surgery </li></ul><ul><ul><li>Long-term effects and success are being studied </li></ul></ul><ul><ul><li>Smaller incisions (2-4 inches) </li></ul></ul><ul><ul><li>Potentially less disruption of muscles and tissues </li></ul></ul><ul><ul><li>May lead to less blood loss </li></ul></ul><ul><ul><li>Potential for less postoperative pain </li></ul></ul>
    6. 6. Difference Between Traditional and Minimally Invasive Hip Replacement Surgery <ul><li>Traditional Hip Replacement Surgery </li></ul><ul><ul><li>Average hospital stay is five days </li></ul></ul><ul><ul><li>Average recovery time of approxmiately 3 months (individuals will vary) </li></ul></ul><ul><ul><li>Leaves a larger scar on patient’s thigh </li></ul></ul><ul><li>Minimally Invasive Hip Replacement Surgery </li></ul><ul><ul><li>May lead to a shortened hospital stay </li></ul></ul><ul><ul><li>May reduce recovery time </li></ul></ul><ul><ul><li>Scars will be smaller and less noticeable </li></ul></ul>
    7. 7. Minimally Invasive Hip Surgery <ul><li>Same implants as traditional hip replacement surgery. </li></ul><ul><li>Components </li></ul><ul><ul><li>Cup </li></ul></ul><ul><ul><li>Ball </li></ul></ul><ul><ul><li>Stem </li></ul></ul>Cup Ball Stem
    8. 8. Ideal Candidate for Minimally Invasive Hip Surgery <ul><li>Suffering from hip arthritis and failed to respond: </li></ul><ul><ul><li>Medicines </li></ul></ul><ul><ul><li>Exercise </li></ul></ul><ul><ul><li>Weight-management programs </li></ul></ul><ul><li>Deciding factors include: </li></ul><ul><ul><li>Medical history </li></ul></ul><ul><ul><li>Weight </li></ul></ul><ul><ul><li>General health </li></ul></ul><ul><ul><li>Body structure, including bone structure </li></ul></ul><ul><ul><li>Extent and pattern of arthritis </li></ul></ul>
    9. 9. Inappropriate Candidates for Minimally Invasive Hip Surgery <ul><li>Severely obese </li></ul><ul><li>Very muscular </li></ul><ul><li>Undergoing complex revision surgeries </li></ul>
    10. 10. Different Techniques Used for Minimally Invasive Hip Surgery <ul><li>Two-Incision </li></ul><ul><li>2 incisions </li></ul><ul><li>Approximately 2 inches in length </li></ul><ul><li>On both front and rear of thigh </li></ul><ul><li>Mini-Incision </li></ul><ul><li>1 incision </li></ul><ul><li>Approximately 3 to 4 inches in length </li></ul><ul><li>Either front or rear of thigh </li></ul>
    11. 11. Different Techniques Used for Minimally Invasive Hip Surgery <ul><li>Two-Incision </li></ul><ul><li>Estimated 80 mins. To 2 hours </li></ul><ul><li>Fluoroscopy may be used. </li></ul><ul><li>Mini-Incision </li></ul><ul><li>Patients lay on their side. </li></ul><ul><li>Fluoroscopy is not used . </li></ul>
    12. 12. Surgical Procedure <ul><li>Incision is made. </li></ul><ul><li>Socket re-shaped to fit new cup implant; replaces the diseased socket. </li></ul><ul><li>New cup placed in socket. </li></ul>Source: www.Allaboutarthritis.com , 2003
    13. 13. Surgical Procedure, continued <ul><li>Femur prepared for the stem. </li></ul><ul><li>Hip stem implanted. </li></ul><ul><li>Ball put in place on top of stem. </li></ul><ul><li>Incision is closed. </li></ul>Source: www.Allaboutarthritis.com , 2003
    14. 14. Benefits of Minimally Invasive Hip Surgery <ul><li>Less trauma to the body. </li></ul><ul><li>Healing and rehabilitation potentially quicker. </li></ul><ul><li>Hospital stays can be shorter. </li></ul><ul><li>Allows for immediate stability of the hip. </li></ul><ul><li>Lower risk of dislocation. </li></ul><ul><li>Potentially less postoperative pain. </li></ul><ul><li>Cosmetically appealing. </li></ul>
    15. 15. Preparing for Minimally Invasive Hip Surgery <ul><li>Strength conditioning enhances recovery. </li></ul><ul><li>Strengthen upper body and opposite leg in preparation for using crutches. </li></ul><ul><li>Visit a physical therapist to: </li></ul><ul><ul><li>Know what to expect in the hospital </li></ul></ul><ul><ul><li>Learn how to protect the hip after surgery </li></ul></ul><ul><ul><li>Get answers to questions about rehabilitation </li></ul></ul><ul><li>Get additional information from www.jointreplacement.com in the physical therapy section. </li></ul>
    16. 16. Before Surgery <ul><li>Medical evaluation will be completed. </li></ul><ul><li>Alleviate anxiety </li></ul><ul><ul><li>Learning more about what to expect </li></ul></ul><ul><ul><li>Sources: </li></ul></ul><ul><ul><ul><li>Patient brochures and videos (distributed by doctor) </li></ul></ul></ul><ul><ul><ul><li>Internet education ( www.jointreplacement.com ) </li></ul></ul></ul><ul><ul><ul><li>Discussion with doctor </li></ul></ul></ul>
    17. 17. Physical Therapist Role <ul><li>The physical therapist will visit the day or day after surgery. </li></ul><ul><li>Physical therapist will assess: </li></ul><ul><ul><li>Range of motion. </li></ul></ul><ul><ul><li>Ability to move in bed. </li></ul></ul><ul><ul><li>Breathing. </li></ul></ul><ul><ul><li>Ability to bear weight. </li></ul></ul><ul><li>Will help with everyday activity evaluation/instruction. </li></ul><ul><ul><li>Using the toilet. </li></ul></ul><ul><ul><li>Bathing. </li></ul></ul><ul><ul><li>Getting in and out of a chair. </li></ul></ul>
    18. 18. Hospital Discharge General Guidelines <ul><li>Accomplish the following activities before leaving the hospital: </li></ul><ul><ul><li>Walking 100 feet with assistive device. </li></ul></ul><ul><ul><li>Learn to climb stairs safely. </li></ul></ul><ul><ul><li>Exercising independently. </li></ul></ul><ul><ul><li>Equipped with assistive devices such as a sock tool, wedge pillow and a raised toilet seat. </li></ul></ul>
    19. 19. Recovery After Surgery <ul><li>The healing hip has a limited range of safe motion. </li></ul><ul><li>Follow safety rules, such as: </li></ul><ul><ul><li>Not crossing your legs. </li></ul></ul><ul><ul><li>Take care when bending. </li></ul></ul><ul><li>Avoid high-impact and contact sports. </li></ul><ul><li>Follow doctor’s instructions for a complete recovery. </li></ul>
    20. 20. Potential Complications and Risks <ul><li>Factors that may affect the rate of complications including. </li></ul><ul><ul><li>The skill of the surgeon. </li></ul></ul><ul><ul><li>Weight, age and overall health of the patient. </li></ul></ul><ul><ul><li>The lifestyle and activities of the patient. </li></ul></ul><ul><ul><li>Presence of osteoporosis or other conditions that weaken bones. </li></ul></ul><ul><ul><li>Patient compliance with instructions. </li></ul></ul>
    21. 21. Potential Complications and Risks, continued <ul><li>Hematoma </li></ul><ul><ul><li>Occurs when blood enters the wound after surgery. </li></ul></ul><ul><ul><li>If excessive, will be drained. </li></ul></ul><ul><li>Fracture </li></ul><ul><ul><li>From weak bones. </li></ul></ul><ul><ul><li>Patient falls. </li></ul></ul><ul><ul><li>Not following precautions. </li></ul></ul>
    22. 22. Potential Complications and Risks <ul><li>Infection </li></ul><ul><li>Dislocation </li></ul><ul><li>Blood clots </li></ul>
    23. 23. The Future of Minimally Invasive Hip Surgery <ul><li>Evolving </li></ul><ul><li>Clinical evidence is being collected </li></ul>
    24. 24. Questions?
    25. 25. Thank You!

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