Traditionally, until a few years ago, hip operations were usually performed using quite large incisions on the side or back of the hip joint. The major disadvantage of these techniques is the need to injure or damage soft tissue structures and muscles. It is not uncommon for bleeding or wound healing disorders to occur in the surgical area.
Minimally invasive operations on the hip have developed steadily over the past ten years and are characterized in particular by a small incision and complete protection of the important muscle structures.
The most commonly used minimally invasive technique on the hip joint is the so-called hip arthroscopy . This is also referred to as a keyhole technique using a camera. The surgeons insert endoscopic probes and surgical instruments through a small incision in the skin. A light source is located at the tip of the endoscope. The image from the camera is transmitted live and magnified to a monitor.
For example, excess bone can be removed or injuries to the joint lip can be treated. However, it is not possible to insert an artificial hip joint using the keyhole technique. Nevertheless, modern endoprosthetics have also developed procedures that are particularly gentle on soft tissue.
In contrast to the past,minimally invasive approaches for hipjoint replacements are now usually performed from the front(AMIS) or from the front and side (ALMIS). So-called muscle gaps or intervals are found here. The muscles are no longer cut or damaged to gain access and visibility to the joint, but special hooks are used to push the muscles to the side. This means that surgery can be performed through a small incision in the skin and without muscle trauma , thus protecting the tissue.
The advantage of this method is that there is no need for a large incision and the surgical wound is significantly smaller. The muscles are not damaged. This means
- less pain for the patient,
- faster healing and
- a lower risk of infection.
After a minimally invasive operation, the patient can usually be mobilized immediately after the procedure, stand up on their own early on and start physiotherapy quickly.
Minimally invasive surgery is particularly suitable for
- younger patients who are still working and
- older people who want to be mobile again more quickly.
Surgeons specializing in these techniques now operate on almost all patients using minimally invasive approaches.
The most common cause of damage to the hip joint is age-related wear and tear: From around the age of 30, the hip joint wears out more and more. In the case of so-called hip arthrosis (coxarthrosis), the thin layers of articular cartilage in the hip joint become severely worn.
This wear process is accelerated by
- Sports injuries,
- accidents,
- poor posture and
- overloading of the joints.
At the end of this degradation process, there is severe pain during movement as well as increasing movement restrictions.
Hip osteoarthritis is one of the most common reasons for minimally invasive hip surgery © Henrie | AdobeStock
Severe hip joint pain can usually be controlled for a while with the help of pain-relieving medication. Physiotherapy and alternative therapies, such as acupuncture, also primarily help to alleviate pain.
However, if such conservative therapies are no longer effective, the patient's level of suffering increases. The use of an artificial hip joint(hip endoprosthesis, hip TEP) should then also be considered.
According to the current guidelines, you are suitable for an operation to insert an artificial hip joint if
- there is significant structural damage to the hip joint (coxarthrosis at least Kellgren/Lawrence grade 3 or femoral head necrosis at least ARCO III c),
- conservative treatment attempts (painkillers, exercise therapy, weight reduction) have not led to sufficient improvement after a period of at least three months,
- despite conservative treatment measures, there is a high level of suffering, which manifests itself in hip-related complaints, restricted movement and a reduced health-related quality of life.
According to the guidelines,contraindications, i.e. reasons that speak against surgery, are
- active infections and inflammation,
- acute or chronic concomitant diseases with a higher mortality risk,
- and a body mass index (BMI) of > 40.
In connection with these factors, there is an increased risk of wound healing disorders and complications after the operation. Doctors may then initially refuse surgery and advise on weight reduction. The same applies to the minimally invasive method.
In recent years, minimally invasive hip surgery has become more popular with patients and is increasingly in demand.
However, minimally invasive hip joint surgery is not suitable for every patient. Whether minimally invasive hip surgery is an option depends on
- the patient's state of health,
- the type of anchoring of the endoprosthesis in the bone and
- the extent of the damage to the hip joint.
joint.
Minimally invasive hip surgery is less suitable for patients with
- previous operations on the hip joint,
- Bone deformities,
- scarring in the area of the operation site,
- extreme obesity.
Minimally invasive hip surgery is performed under anesthesia.
Unlike conventional hip joint surgery, the surgeon does not simply make long incisions through the skin and muscles. Instead, he pushes muscles, tendons and nerves as far to the side as possible in order to reach the hip joint. With the minimally invasive surgical approach, no muscle cords need to be severed. The muscle trauma for the patient therefore remains minimal.
The joint is exposed via the small skin incision . The surgeon cuts through the femoral neck and removes the worn femoral head.
He then works on the hip socket and the femur so that an artificial hip joint can be inserted. The socket and stem are implanted for this purpose.
In the case of cementless implants, these are usually made of titanium. For joint components that move against each other (bearing couples), you can choose between ceramic or polyethylene. Nowadays, the femoral head is usually made of ceramic.
After a short functional test to check the mobility of the artificial hip joint, the wound is rinsed and sutured.
Short stem prostheses are advantageous for minimally invasive approaches
The goal of implantation through a small skin incision that is gentle on soft tissue and muscle can be achieved much better with short stem prostheses than with conventional straight stem prostheses. Short stem prostheses can be inserted better "around the curve" due to their short and round shape. This makes the hip operation much easier for an experienced surgeon. However, as the technique for implanting short stem prostheses differs from conventional stems, patients should always consult a hip specialist with extensive experience in this field.
The operation usually proceeds without any major complications at special centers for orthopaedics and hip joint surgery. Patients can and should begin exercise therapy and mobilization on the day of the operation.
Independent walking with walking aids is therefore usually possible very early on. The patient is initially dependent on walking aids for the first few weeks.
Good rehabilitation also has a decisive influence on the success of minimally invasive hip surgery. Today, inpatient rehabilitation is usually no longer necessary. Young patients in particular generally benefit more from individually tailored outpatient follow-up treatment.
