Surgeons choose from a vast array of implants produced by various manufacturers. Materials and clinical engineering of these implants vary. Talk with your surgeon about which implant he or she plans to use for your particular circumstances. Your surgeon can explain the clinical results of the implant chosen for you and tell you why he or she thinks this implant is the best choice. The surgeon's criteria may include:

++ Shape and design for optimum fit within the patient's anatomy
++ History of long-term stability and adhesion – called fixation
++ Material
++ Ability to reestablish the patient's natural range of motion
++ Cost
++ Consideration of hospital-negotiated contracts
++ Comfort with the surgical instruments associated with the preferred implant
++ The surgeon's confidence in the implant manufacturer's clinical success rate and product quality

With an extensive range of implant products available, your surgeon can choose the solution that he or she thinks will be best for you, based on your disease, anatomy, lifestyle and other criteria. As with any medical treatment, individual results may vary. Only an orthopaedic surgeon can determine whether an orthopaedic implant is an appropriate course of treatment. There are potential risks, and recovery takes time. The performance of the new joint depends on weight, activity level, age and other factors. These need to be discussed with your doctor.

Mini-Incision or Two Incision: What is the Difference?

One of the most significant advancements in total hip replacement is the medical community’s recognition that the procedure can be done with minimally invasive techniques potentially allowing patients to recover faster.

Minimally invasive surgery is not new. It has been performed for years on knees and on some cardiac patients.

The goal of minimally invasive hip replacement is simply to minimize the amount of soft tissue damage that occurs when a surgeon reconstructs a hip. In the end, this can lead to the potential for less pain, quicker healing, and shorter recovery time.

Minimally invasive hip replacement allows surgeons to implant the traditional hip components through one or two small incisions rather than the traditional 12 to 18 inch incision.

A minimally invasive procedure is performed through one 3 to 4-inch incision, known as the mini-incision approach or technique, or the two-incision approach, utilizing two 1.5 to 2 inch incisions.

The Mini-Incision Technique
The mini-incision technique is similar to the traditional hip replacement, but the one skin incision made is very small. Through careful positioning of the surgical incision, trauma to soft-tissue structures such as skin and muscle can be reduced through the mini-incision technique. Because less skin, muscle, and other soft tissues are involved, patients can potentially recover quicker, spend fewer days in the hospital, and return to their active lives sooner.

The Direct Two-Incision Technique
Because of the small exposure associated with preparation of the femoral canal (leg bone) with the small incision technique, the two-incision approach was developed to provide more precision in preparing the femoral (leg bone) canal for the new ball component. This technique uses one incision for preparing and inserting the socket. The second incision is used to prepare and insert the thighbone component. Only one muscle structure is cut, while other soft tissue structures such as ligaments and tendons are moved aside instead of being cut. In addition, another important benefit of this technique is the sparing of the fascia latae (deep sheet tissue surrounding the thigh muscle). As a result, this may reduce the occurrence of localized pain over the greater trochanter and provide greater hip stability immediately after surgery.

The sparing of the fascia latae is very important as it plays a pivotal role in providing abductor strength. The hip area is made up of many muscles that aid in its movement, and the abductor muscle group keeps your body’s trunk upright. In the case of an individual undergoing hip replacement surgery, there is considerable concern that weakened abductor muscles may be associated with a higher chance of dislocation. The lack of cutting through lateral (side) and posterior (back) soft tissues also allows for immediate stability of the hip and potentially lower risk of dislocation.

Because the small incisions cause less trauma to the body, healing and rehabilitation can potentially begin sooner. Patients may also experience a shorter hospital stay, with some patients being discharged the same day surgery is performed. However, early discharge is open to debate and is still the decision of the surgeon.

Only an orthopaedic surgeon can determine whether you are a candidate for the minimally invasive hip replacement procedure. As with any surgery, there are risks. Recovery takes time and hard work. The life of a new joint depends on weight, activity level, age and other factors. Each patient responds differently. The most common adverse events include loosening, deformation or wear of one or more components, osteolysis, infection, fracture of the components or bone, change in position of the components, dislocation and tissue reaction. Also, a mini-incision may need to be converted into a traditional incision during surgery. While studies are being conducted, many surgeons may still prefer to perform traditional hip replacement surgery.

As with any medical treatment, individual results may vary. Only an orthopaedic surgeon can determine whether an orthopaedic implant is an appropriate course of treatment. There are potential risks, and recovery takes time. The performance of the new joint depends on weight, activity level, age and other factors. These need to be discussed with your doctor.

Discharge Planning After Hip Replacement Surgery

You may be released from the hospital after hip replacement surgery if your physical therapist and surgeon feel you are comfortable with the following:

++ You know all the hip precautions for all your activities
++ You are independent in all transfer activities
++ You know and are correctly performing your exercise program
++ You are able to walk on level surfaces for at least a distance of 100+ feet, and climb stairs.

There is a possibility your therapist and orthopaedic surgeon will indicate other discharge destinations such as a short-stay rehabilitation facility or a long-term care facility.

You will receive a detailed home program from your physical therapist prior to your release from the hospital. Your therapist will check to see if you can get in and out of bed safely, walk with the right amount of weight on your hip using a walking aid, go up and down stairs safely, and do your exercises by yourself. In addition, some of the assistive equipment that should be made available to you such as a wedge pillow, long handled reacher, sock donner, long-handled sponge, extended shoe horn, elevated toilet seat, shower equipment, etc.

If you are going home by car, you will be instructed how to safely get in the car while maintaining your hip precautions. Do not get into the car from the curb. The car should be far enough away from the curb that you are able to stand on the street. The front seat should be pushed as far back as possible. You will want to back up to the front seat, then sit and slide toward the middle of the seat maintaining your back in a semi-reclining position keeping your operated hip as straight as possible. Gently slide both legs into the car being mindful of the operated hip position.

Safety instructions may also be given to you and your family so they can assist you at home. These instructions may include:

++ Moving small scatter rugs
++ Tacking down loose carpeting
++ Moving telephone wires and lamp cords out of the way so that you do not trip over them
++ Making sure small pets do not get underfoot
++ Adjusting the height of furniture
++ Finding non-soft chairs in which to sit
++ Using a stair railing
++ Installing shower railings
++ Being sure shower base is a non-slip surface
++ Wearing only slippers and shoes that have backs
++ Taking a few seconds when transitioning from lying to sitting and from sitting to standing so that you do not get dizzy
++ Have adequate lighting, for example, night-lights in bedrooms, hallways, and bathrooms.