Dr. De Smet How big is the incision of the (hip resurfacing) operation?
In a classic total hip replacement the length of incision is
between 8 – 15 cm (3-6 inch), depending on the difficulty of the
operation (e.g. revision surgery and obesity of the patient). In
the resurfacing procedure the incision is longer (15 – 30
cm/6-12 inch) because of technical-anatomical reasons (saving
the femoral head). The length of incision has no influence in
the postoperative rehabilitation.
Minimal invasive surgery is not applicable to resurfacing
today. Minimal invasive surgery in total hip corresponds with a
lot of early complications (17%). The prosthesis placement is
often “blind”. A reduction of the incision to “minimal incision”
is done by everybody. The 2-incision minimal invasive technique
is disregarded by most of the surgeons.
Dr. Gross What is minimally invasive surgery?
There is a trend toward performing all types of surgery in a
less invasive fashion with smaller incisions. Like all new
developments, it is somewhat controversial. Minimally invasive
techniques are more difficult to master, and every surgeon is
not well qualified to attempt this. In the hands of some
surgeons, complication rates have been much higher than for
traditional surgery. Others have shown excellent results. I have
developed minimally invasive techniques for almost all types of
primary (not revision) joint replacement that I perform. My
complication rates are lower with minimally invasive surgery
than those generally published for traditional surgery.
When I perform minimally invasive surgery, I use “extensile”
incisions that can at anytime be increased in length if more
access is required in a particular case. I do not hesitate to
use this option when necessary. I believe inserting the implants
properly is a much higher priority than a small incision or a
quicker healing time. However, large incisions are only rarely
necessary unless the patient is very obese or muscular.
Typical incision lengths:
Hip Surface Replacement: 4 inches
Stemmed Total Hip Replacement: 3 inches.
What is the advantage of minimally invasive surgery?
The advantage is less postoperative pain and a better
cosmetic result as well as a more rapid healing time. We can now
discharge most patients from the hospital within one to two days
after surgery using these techniques.