Minimally Invasive Surgery

Minimally Invasive Knee Replacement

High flexion rotating platform knee replacement surgery, also called mobile bearing high bending knee is the latest and most modern advancement in the field of knee replacement surgery. The various types of knee replacement implant available in the market do not allow one squat or sit cross-legged, with high flex cross rotation platform knee replacement surgery, one can do this. Rotating Platform High Flexion is one very few implants, at the moment that gives the combination of high knee flexi0on and rotation. The advantage of rotation is that it gives movement in two planes, similar to normal knee, being minimally invasive, and the incision in the skin is much smaller and recovery is faster.

HOSMAT is the first hospital in South India to have a Computer-aided system, ROTATING PLATFORM knee replacement surgery, High Bending and Minimally Invasive system of surgery. The computer navigation system helps in dong a smaller incision with exact precision. The computer identifies shapes and size of the joint along with various angles by degrees. Manually, one can go wrong by a few degrees. The benefits of rotating platform high bending knee replacement surgery is-

  • Deep flexion ranging from 120 to 140as a normal knee with reduced wear
  • Rotational Freedom in deep flexion
  • Allow kneeling, squatting and sitting cross legged, praying on the floor
  • Excellent, bending & rotation
  • Active lifestyle with long implant life
  • Ideal for younger and middle aged active patient up to 65 yrs.

A knee replacement allows a patient to walk normally without pain, to perform all activities of daily living, work & certain play activities like long walk, dancing, golf, swimming & bicycle riding

Minimally Invasive Hip Replacement

Total hip replacement is a common procedure. It involves removing the head of the thighbone (femur). The ball-and-socket mechanism of the hip is replaced with artificial implants.

Newer techniques and implants have been developed. They make hip replacement a less invasive operation. It takes less time for the patient to recover from surgery. The new implants are engineered to last longer

Diagnosis

Osteoarthritis of the hip is the most common diagnosis that leads to hip replacement. Osteoarthritis is caused by wear and tear. It affects the cartilage surfaces of the ball-and-socket joint of the hip. The cartilage wears out. Pain and stiffness result. Patients with hip arthritis have difficulty walking, climbing stairs and performing routine daily activities.

Other conditions that can cause destruction of the hip joint include:

  • Loss of the blood supply to the head of the thighbone (avascular necrosis)
  • Rheumatoid arthritis (an inflammatory autoimmune disease)

See your doctor to diagnose hip arthritis. Many hip patients have difficulty with walking and day-to-day activities like putting on shoes and socks or climbing stairs. Tell the doctor your symptoms. He or she will perform a physical examination and order X-rays. X-rays typically show loss of the cartilage space in the hip socket. It looks like there is "bone-on-bone". Bone spurs and bone cysts are common. Sometimes, the doctor may recommend additional tests to confirm the diagnosis. These may include MRI (magnetic resonance imaging) or CT (computed tomography) scans.

Risk Factors/Prevention

Hip arthritis may happen if you have a previous injury or mechanical abnormalities related to how the hip developed. Most patients develop arthritis as a result of lifelong wear and tear. Arthritis develops slowly. It takes a period of years. Symptoms increase gradually over time.

Some bone diseases may contribute to the development of hip arthritis. Patients with arthritis may also have brittle bones (osteoporosis). But there is no direct relationship between bone density and the development of arthritis of the hip.

Symptoms

Hip arthritis typically causes pain that is dull and aching. The pain may be constant or it may come and go. You may feel pain in the groin, thigh and buttock. You may also have pain in the knee (referred pain). Walking, especially for longer distances, may cause a limp. Some patients may need a cane, crutch or walker to help them get around. Pain usually starts slowly. It gets worse with time, and higher activity levels.

Climbing stairs can be difficult. Many patients with hip arthritis have to use a stair rail or stop on each step to get up and down. Dressing, tying shoes and clipping toenails can be difficult or impossible. You may have pain when you rest. Pain may interfere with your sleep. Resting and taking anti-inflammatory or pain medication can help.

Treatment Options

The first treatment a doctor may recommend is to take prescription or over-the-counter, anti-inflammatory medications. These include ibuprofen (Motrin®or Advil®acetaminophen (Tylenol®or mild combination narcotics (Tylenol® with codeine). Some nutritional supplements may also provide some relief. These include glucosamine. Short-term physical therapy may help with strength and stiffness.

For more advanced arthritis, you may need to use a cane in the hand opposite the affected hip. This transfers weight away from the affected hip. It can improve walking ability. Using a walker may help patients who have more trouble walking. These measures usually improve pain and function. But arthritis is progressive. Even with treatment, it gets worse over time. Weight loss can help decrease stresses on all of the joints. If you are overweight, you should strongly consider losing weight

Treatment Options: Surgical

Even when you get all of the right nonsurgical treatments, problems with pain and mobility sometimes get worse. In this case, the doctor may recommend surgery. Surgical options include:

Arthroscopy

Arthroscopy of the hip is a minimally invasive, outpatient procedure. It is relatively uncommon. The doctor may recommend it if the joint has evidence of torn cartilage or loose fragments of bone or cartilage.

Osteotomy

Candidates for osteotomy include younger patients with early arthritis, particularly those with abnormally shallow hip socket (dysplasia). The procedure involves cutting and realigning the bones of the hip socket and/or thighbone. This creates a more normal relationship between the ball and socket. It decreases pressure in the joint. In some cases, this may delay the need for replacement surgery for 10 to 20 years.

Traditional Hip Replacement

The doctor may recommend hip replacement when all of the above measures have been considered or have been tried and failed. Traditional hip replacement surgery involves making a 10-inch to 12-inch incision on the side of the hip. The muscles are split or detached from the hip. The hip is dislocated. The ball of the femur is removed. The hip socket is prepared by removing any remaining cartilage and some of the surrounding bone. The cup implant is pressed into the bone of the socket. It may be secured with screws. A bearing surface is inserted into the socket.

Next, the femur is prepared by removing some bone from the inside of the thighbone. A metal stem is placed into the thighbone to a depth of about 6 inches. The stem implant is either fixed with bone cement or is implanted without cement. Cement less implants have a rough, porous surface. It allows bone to adhere to the implant to hold it in place. A ball is then placed on the top of the stem. The ball-and-socket joint is recreated.

Minimal Incision Hip Replacement

Minimal incision hip replacement surgery lets the surgeon perform hip replacement through one or two smaller incisions. Compared with most people getting hip replacements, candidates for minimal incision procedures are typically thinner, younger, healthier and more motivated to have a quick recovery. Before you decide to have a minimally invasive hip replacement, get a thorough evaluation from the operating surgeon. Discuss with him or her about the risks and benefits. Both traditional and minimally invasive hip replacement procedures are technically demanding. They require that the surgeon and operating team have considerable experience.

The artificial implants used for the minimally invasive hip replacement procedures are the same as those used for traditional hip replacement. Specially designed instruments are needed to prepare the socket and femur and to place the implants properly. The artificial hip is implanted in the same way. But there is less soft-tissue dissection than with longer incisions.

A single minimally invasive hip incision may measure only 3-inches to 6-inches. It depends on the size of the patient and the difficulty of the procedure. The incision is usually placed over the outside of the hip. The muscles and tendons are split or detached, but to a lesser extent than in the traditional hip replacement operation. They are routinely repaired after the surgeon places the implants. This helps healing. It helps prevent dislocation of the hip.

Two-incision hip replacement involves making a 2-inch to 3-inch incision over the groin for placement of the socket and a 1-inch to 2-inch incision over the buttock for placement of the stem. To perform the two-incision procedure, the surgeon needs guidance from X-rays. It may take up to two or three times as long to perform this surgery, as it takes to perform traditional hip replacement surgery.

Reported benefits of less invasive hip replacement include:

  • Less pain
  • More cosmetic incisions
  • Less muscle damage
  • Rehabilitation is faster
  • Hospital stays are shorter--For traditional hip replacement, hospital stays average four to five days. Many patients need extensive rehabilitation afterward. With less invasive procedures, the hospital stay may be as short as one or two days. Some patients can go home the day of surgery.

Early studies suggest that minimally invasive hip replacement surgery streamlines the recovery process. But the risks and long-term benefits of the less invasive techniques have not Minimally invasive surgery is the trend for the future - there is no question about it. Someday, most surgeons will be performing this, but as in anything else in life, all surgeons will not be able to.

It should also be noted that while it is easy to say that minimally invasive surgery is the current trend, it is not something that is suited for everybody. Total body weight is not the major factor in determining whether or not patients can undergo a small incision. The size of their bone and the thickness of the subcutaneous fat and underlying muscle must all be determined so that no undue trauma will be imparted to the soft tissues in an attempt to make the skin incision look smaller. It also should be noted that minimally invasive surgery is a technically demanding operation. It should not be performed by the occasional hip surgeon, but rather experienced hip surgeons with an experienced team assisting them. As my patients know, my team consists of myself, two nurses and a physician's assistant who operate on all patients together. Without the aid of these assistants, performing minimally invasive surgery would not only be more difficult, it would be more traumatic to the patients, add on to the surgical time, and most likely have an adverse effect on the excellent results that we are now seeing.

Minimally invasive surgery is the trend for the future - there is no question about it. Someday, most surgeons will be performing this, but as in anything else in life, all surgeons will Minimally invasive surgery is the trend for the future - there is no question about it. Someday, most surgeons will be performing this, but as in anything else in life, all surgeons will not be able to