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Minimally Invasive Hip Surgery What is Minimally Invasive

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  • Source “ Frequently Asked Questions About Minimally Invasive Hip Replacement Surgery” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.minimally-invasivehip.com Notes To begin, introduce yourself. Try to include key points, such as Clinic Name Years of Practice Your specialty Purpose of presentation Minimally invasive hip replacement surgery involves the use of smaller incisions to replace the worn out hip with an implant. Some 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.minimally-invasivehip.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.minimally-invasivehip.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 “ Frequently Asked Questions About Minimally Invasive Hip Replacement Surgery” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.minimally-invasivehip.com
  • Source “ Small Incision or Two-Incision: What is the Difference?” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.minimally-invasivehip.com Notes 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 “ Frequently Asked Questions About Minimally Invasive Hip Replacement Surgery” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.minimally-invasivehip.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.minimally-invasivehip.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 “ What is body composition, and why is it important? ” American Heart Association, 2 nd , April 2003. www. http://www.s2mw.com/simplesolutions/bmiinfo.html Obesity is defined as a BMI of 30.0 or greater (based on 1998 NIH guidelines), or about 30 pounds or more overweight. People with BMIs of 30 or more are at higher risk of cardiovascular disease. Extreme obesity is defined as a BMI of 40 or greater.
  • Source “ Frequently Asked Questions About Minimally Invasive Hip Replacement Surgery” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.minimally-invasivehip.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 “ Frequently Asked Questions About Minimally Invasive Hip Replacement Surgery” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.minimally-invasivehip.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.minimally-invasivehip.com Notes 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. The X-rays are taken by one of the instruments inside the patient to guide the surgeon in cutting out the diseased joint and implanting the prosthesis or ball and socket.
  • Source “ What is Fluoroscopy and How is It Used in Minimally Invasive Hip Surgery?” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.minimally-invasivehip.com Notes There are advantages and disadvantages to using fluoroscopy in MIH surgery. The surgeon increases his or her ability to perform more accurately the minimally-invasive procedure while gaining access to difficult-to-reach areas. The patient benefits from a safer and shorter procedure resulting in potentially less trauma, a shorter hospital stay, and faster recovery time. However, there are also great concerns about using fluoroscopy, particularly because of the excessive radiation exposure. A minimally invasive hip replacement surgery can take up to two hours, which means an extended time of radiation exposure. If you have concerns about exposure to X-rays, talk to your surgeon about fluoro-free alternatives to minimally invasive hip replacement.
  • Source “ Hospital Stay and Rehabilitation After Minimally Invasive Hip Replacement Surgery” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.minimally-invasivehip.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. Because MIH surgery is new, data is being collected to compare these goals with traditional surgery. Patients undergoing minimally invasive hip surgery can expect similar care during their hospital stay as those being treated with traditional hip surgery.  The benefits of MIH surgery are realized early in the rehabilitation process, most notably in the first three months of recovery. Doctors expect speedier rehabilitation because the procedure decreases trauma to major muscles and tissue of the upper legs.  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
  • Source “ Potential Complications Associated with Minimally Invasive Hip Surgery” DePuy Orthopaedics, Inc., 2 nd , April 2003. www.minimally-invasivehip.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.
  • Transcript

    • 1. Minimally Invasive Hip Surgery
    • 2. What is Minimally Invasive Hip Surgery?
      • A new surgical technique
      • Uses traditional hip implants.
      • Two different techniques, including mini-incision and two-incision.
    • 3. Traditional VS Minimally Invasive Hip Replacement Surgery
      • Traditional Hip Replacement Surgery
        • Proven in clinical studies and successfully performed for decades
        • Allows surgeon full visualization of operative area
        • Larger incision (8-10 inches)
        • More disruption of muscles and tissues
      • Minimally Invasive Hip Replacement Surgery
        • Long-term effects and success are not established.
        • Restricted visualization of operation area.
        • Smaller incisions (2-4 inches)
        • Potentially less disruption of muscles and tissues
        • May lead to less blood loss and postoperative pain
    • 4. Traditional VS Minimally Invasive Hip Replacement Surgery
      • Traditional Hip Replacement Surgery
        • Average hospital stay is five days
        • Average recovery time of approx. 3 months (individuals will vary)
      • Minimally Invasive Hip Replacement Surgery
        • May lead to a shortened hospital stay, less than 5 days.
        • May reduce recovery time
    • 5. Traditional VS Minimally Invasive Hip Replacement Surgery
      • Traditional Hip Replacement Surgery
      • Minimally Invasive Hip Replacement Surgery
    • 6. Benefits of Minimally Invasive Hip Surgery
      • Less trauma to the body.
      • Healing and rehabilitation potentially quicker.
      • Shorter hospital stays
      • Allows for immediate stability of the hip
      • Lower risk of dislocation.
      • Potentially less postoperative pain.
      • Cosmetically appealing
    • 7. Ideal Candidate
      • Suffering from hip arthritis
      • Failed response to:
        • Medicines
        • Exercise
        • Weight-management
      • Deciding factors include:
        • Medical history
        • Weight
        • General health
        • Body structure, including bone structure
        • Extent and pattern of arthritis
    • 8. Inappropriate Candidates
      • Severely obese (BMI of 40 or greater)
      • Very muscular
      • Undergoing complex revision surgeries
    • 9. Minimally Invasive Hip Techniques
      • Two-Incision
      • 2 incisions
      • Approximately 2 inches in length
      • On both front and rear of thigh
      • Fluoroscopy may be used.
      • Mini-Incision
      • 1 incision
      • Approximately 3 to 4 inches in length
      • Either front or rear of thigh
      • Fluoroscopy is not used .
    • 10. Techniques: Two Incision vs Mini Incision
      • Two-Incision
      • Mini-Incision
    • 11. Fluoroscopy
      • Real-time x-ray images to define instruments positions during surgery.
      • Guides position of implants
      • Sometimes used with smaller incisions.
    • 12. Fluoroscopy: Benefits and Risks
      • Benefits:
        • Increases surgical accuracy
        • Safer and shorter procedure.
      • Risks:
        • Increased radiation exposure
        • Minimal long term effects
    • 13. Recovery After Surgery
      • MIH benefits shown in the first 3 months of recovery
      • Patient must follow hip precautions:
        • Not crossing their legs
        • Take care when bending
      • Avoid high-impact and contact sports.
    • 14. Risk Factors
      • Factors that may affect the rate of complications including
        • Surgeon skill
        • Weight, age and overall health of the patient
        • Current lifestyle and activities of the patient
        • Presence of osteoporosis or other conditions that weaken bones
        • Patient compliance with physician instructions
    • 15. Potential Complications and Risks
      • Hematoma
        • Occurs when blood enters the wound after surgery.
        • If excessive, will be drained.
      • Hip Fracture
        • Occurs during or after surgery
        • Caused by:
          • Weak bones
          • Falling
          • Failure to follow hip precautions
    • 16. Potential Complications and Risks
      • Infection
        • About 1% change of infection after surgery
      • Dislocation
        • Occurs when the ball of the hip comes out of the socket.
        • Caused by:
          • size
      • Blood clots
    • 17. Questions?
    • 18. Thank You!