Minimally invasive hip surgery

Minimally invasive hip surgery: What is it?

Minimally invasive surgical techniques are becoming increasingly attractive alternatives to conventional hip surgery. They avoid large skin incisions and spare surrounding tissues such as muscles, tendons, or nerves. This enables faster postoperative tissue healing, a lower rate of complications, and a better cosmetic outcome.

The hip joint connects the pelvis with the femur and has a large range of motion. It is stabilized by strong muscles and tendons to enable the transfer of force from the upper body to the lower extremities. Therefore, in conventional surgery, these muscles are either cut or significantly stretched to access the inside of the joint. In contrast, minimally invasive surgery uses naturally occurring gaps in the musculature, sparing them during the procedure. Moreover, nearby blood vessels and nerves are also better protected with this technique.

When is hip surgery necessary?

The hip joint can be affected by various diseases, leading to pain, restricted movement, or instability. In most cases, a conservative approach is pursued before any surgery. If conservative treatment does not sufficiently relieve the symptoms, a surgical intervention should be considered.

Degenerative diseases of the hip joint

The most common indication for hip surgery is advanced osteoarthritis, also referred to as coxarthrosis. It is a progressive degenerative disease of the joint, resulting in the wear of the protective cartilage. Asa a result, the bony parts of the joint lose their protective cushioning and start to rub against each other, causing pain and restricted movement. A very typical symptom of hip osteoarthritis is “start-up pain”, which improves with movement but worsens with increased strain.

Advanced hip osteoarthritis often cannot be sufficiently treated with conservative methods and at this stage, surgical treatment is generally recommended. This involves replacing the hip joint with a prosthesis. Depending on the extent of the degeneration, either both the femoral head and acetabulum are replaced, or only the femoral head.

Malalignment of the hip joint

Malalignment of the hip joint can be congenital or acquired. Hip dysplasia is a common example of congenital deformity, in which the acetabulum does not fully cover the femoral head, resulting in insufficient joint stability. Newborns can be screened via ultrasound to detect this condition early. If it is diagnosed early, full recovery can be achieved through conservative measures. However, in some cases, hip dysplasia can lead to deformities that require surgical treatment.

An uncorrected malalignment of the hip can promote the development of hip osteoarthritis at a young age. In advanced osteoarthritis, a hip joint prosthesis may become necessary.

An osteotomy can be performed to restore the normal anatomy of the joint and correct any deformities without replacing the joint. This procedure is performed by cutting the bony components of the joint, realigning and fixating them in the correct position.

Furthermore, traumatic injuries such as bone fractures or tendon ruptures can cause acute deformities of the joint that require surgical correction. 

Inflammatory diseases of the hip joint

Any inflammation affecting a joint should be treated as soon as possible. This may be caused by bacteria or by other underlying conditions. For example, rheumatic conditions can trigger inflammatory reactions without bacterial involvement. Even though conservative methods are preferred initially, advanced stages may require surgical intervention.

Minimally invasive surgery: What techniques are available?

A well-known and widely established minimally invasive technique is arthroscopy, which can also be performed on the hip joint. This involves inserting various instruments into the joint through tiny skin incisions, thereby minimizing trauma to surrounding tissues. This procedure, also referred to as keyhole surgery, uses an endoscope, which is a flexible tube equipped with a small camera. It allows the surgeon to visualize the inside of the joint as well as the inserted instruments on a monitor.

Minimally invasive hip surgeries can also be performed without using an endoscope, relying on specific surgical approaches to the joint. The anterior approach to the hip takes advantage of an anatomical gap between the muscles, preserving the surrounding soft tissues. One such example is the AMIS technique (anterior minimally invasive surgery), which is often used during hip replacement surgery.

Who is suitable for minimally invasive hip surgery?

Elderly, patients with pre-existing conditions, or overweight individuals are well-suited for minimally invasive hip surgery. This patient group not only benefits from the lower complication rate but also from a faster postoperative recovery. Mobility can be resumed earlier due to the gentler nature of the procedure. Moreover, prolonged bed rest can be avoided.

In addition, very muscular patients also benefit from minimally invasive surgical techniques, as intraoperative muscle cutting or stretching can be avoided. 

What are the advantages and disadvantages of the minimally invasive method?

The main advantage of minimally invasive surgical techniques in hip surgery is the preservation of soft tissues surrounding the hip joint. As a result, complication rates are lower, and the rehabilitation time is shorter. The use of small skin incisions not only allows for faster wound healing but also for a better cosmetic outcome. One such example is the “bikini technique”, during which an incision is made along the groin fold, resulting in an almost invisible surgical scar afterwards.

Unfortunately, not every hip surgery can be performed using a minimally invasive approach. For instance, if an existing hip prothesis needs to be replaced, open surgery is usually required to adequately access the joint. Moreover, minimally invasive techniques require specially trained surgeons and specialized equipment in the operating room.

However, if all these conditions are met, many patients can benefit from the above-mentioned advantages. 

What should be considered after hip surgery?

Every hip surgery requires an individual postoperative regimen to ensure an optimal surgical outcome. This treatment plan is created by the surgeon, taking into account the patient’s condition, surgical technique, and any pre-existing diseases.

Following minimally invasive hip surgery, a prolonged period of rest is generally not required, allowing the patient to begin physiotherapy early. Lymphatic drainage may also be beneficial during the first postoperative weeks. The increase in weight-bearing should follow the established rehabilitation plan. Moreover, regular follow-up appointments should be scheduled.

What physicians and clinics specialize in minimally invasive surgery?

Physicians specialized in performing minimally invasive hip surgery are orthopedic and trauma surgeons with an additional subspecialty training in hip surgery. They are the most qualified experts to address all questions regarding minimally invasive surgical techniques for the hip.

We would like to assist you in finding a suitable expert for your condition. Therefore, we have carefully curated a list of specialists based on their expertise in minimally invasive hip surgery. They are all highly experienced in performing various surgical techniques of the hip. Benefit from the expertise of our specialists and schedule your first personal consultation quickly and hassle-free.