Minimally Invasive Anterior Hip Replacement

Before the Operation: Principles of this Technique

Minimally invasive hip replacement is a breakthrough in hip arthroplasty offering potential advantages over standard surgical procedures.

As with any surgical operation, minimally invasive anterior hip replacement requires some pre-operative preparation:

• Signing the Informed Consent Form: The doctor will explain the procedure and all possible complications of the operation, which, although unusual, must be known. You should ask the doctor anything you want to know;
• Preoperative Assessment: Hip replacement surgery requires a preoperative examination including a complete blood count to check the patient's health status; an electrocardiogram to check the heart health of the person to be operated on; and finally a chest X-ray to check that the trachea is correctly aligned and to ensure there are no signs of infection;

Inform the doctor of the following:

• Allergies: If the patient has had problems during previous anesthesia, if they are allergic to latex or any element used during the operation, this must be indicated. This is usually the doctor themselves who asks the question;
• Medications: It is important to tell the doctor or anesthesiologist about any type of medication, prescription or over-the-counter, that the patient is taking, as they may influence the smooth running of the operation and must be monitored;
• Anticoagulant Medications: This point is linked to the previous section, but it is even more important. If the patient has a history of coagulation disorders or is taking anticoagulant medications, the doctor must be informed, as this can affect coagulation;
• Pregnancy: It is rare for a woman of childbearing age to need hip arthroplasty, but if this is the case and you know or think you are pregnant, you must inform your doctor immediately;

During the Operation

The procedure is performed via an anterior approach using a "bikini" incision that will be hidden under clothing, resulting in minimal aesthetic impact on the patient's life.

Classic hip operations (performed posteriorly, i.e., through the buttock) involve the disinsertion (removal) of muscles to implant the hip prosthesis, so the muscles must be reconstructed afterward. However, with this technique, the surgeon accesses between the muscles without damaging them, respecting the anatomical elements of the body.

Using intraoperative X-rays, the surgeon ensures that the size of the hip prosthesis is the most suitable.

In the medium term, the capacity for dislocation of the hip prosthesis is reduced to practically zero and the patient is allowed all types of movement from the first postoperative day.

After Hip Replacement Surgery

Four hours after the operation, the patient can walk with crutches and, within 48 hours, they can go home with very advanced recovery in terms of pain reduction and greater autonomy. With the traditional technique, hospital discharge is extended to the seventh day.

Furthermore, with the traditional procedure, after the operation, the patient must avoid certain movements as they could cause dislocation of the prosthesis, which does not happen with this minimally invasive technique because, as the muscles are not disinserted, they maintain their stability.

With this technique, rapid recovery is achieved with a shorter recovery time after hip replacement and, in the long term, the ability to regain all the mobility and physical activity the patient may need. The minimally invasive technique also reduces muscle pain after hip replacement.

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Post-Operative Recovery

Regarding physiotherapy treatment, initially, the patient will only do muscle strengthening exercises. Subsequently, they will be able to move on to more intense activities (walking, swimming, stationary bike).

Prohibited Hip Replacement Movements: The physiotherapist will tell the patient which movements they can make and which movements are prohibited with a hip prosthesis.

Thanks to appropriate rehabilitation, the patient will be able to resume their normal daily activities 2 to 4 weeks after the operation, return to work or drive after 4 to 6 weeks, and resume sports activities after about 3 to 4 months. However, they should avoid high-impact sports (football, basketball, etc.).

Advantages of Minimally Invasive Anterior Hip Replacement

The concept of minimally invasiveness is broad and articulated. It involves applying a surgical technique that respects muscle, nerve, and bone tissues as much as possible.  

Several minimally invasive surgical techniques are described and practiced.

The minimally invasive anterior approach is the only truly minimally invasive technique in that it does not involve detaching tendons or muscles and involves passing between inter-nervous planes. In essence, it is a truly minimally invasive surgical technique in that it globally respects and preserves tissues. Compared to traditional prosthetic surgery, the minimally invasive technique offers unique advantages.

Revision hip replacement, if it restores joint function by replacing the entire joint (including the acetabulum, i.e., the hemispherical cavity that houses the femoral head), proves very effective.

The damaged cartilage and bone are carefully removed and replaced with a particularly strong prosthesis.

These advantages are made possible by the use of this technologically advanced, smaller, stronger, and biologically anchored prosthesis, made from advanced and safe biocompatible materials. The success of the operation undoubtedly depends on the surgeon's manual dexterity and the most precise design of the prosthesis.

Here, in detail, are the advantages of minimally invasive hip replacement:

• faster surgery, hospitalization, rehabilitation, and recovery times, even halved;
• reduced incision, hence less blood loss, no need for blood transfusions, less visible scar;
• reduced trauma (pain and swelling);
• sparing of muscles, cartilage and bony parts, preservation of a good part of the femoral neck, periarticular structures, nerves and vessels;
• reduction of friction between the components of the femoral head and the acetabulum;
• reduction of complications and adverse events such as the risk of dislocation;
• Everything, in short, is reduced, except the lifespan of the prosthesis (20-25 years on average). Minimally invasive surgery is successful in 90 to 95% of cases;

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