Tiny Cut Means Less Pain, Quicker Recovery

Take a look at a 12-inch ruler. That's nearly as long as the incision used in a conventional hip replacement. Now cover up 75 percent of that ruler, so you have only 3 inches showing. That's the size of the incision made by Kelsey-Seybold Clinic Orthopedic Surgeon Glenn C. Landon, M.D., during a pioneering hip replacement on May 22, 2002, at St. Luke's Episcopal Hospital.

"We continue to use state-of-the-art implants and careful surgical technique," explained Dr. Landon, chairman of the Orthopedic Department at Kelsey-Seybold Clinic. "The difference is, I'm using a minimal, 3-inch incision versus an 8- to 12-inch incision. There's less bleeding, less pain, and quicker recovery."

"Much More Positive Experience for Patient"

Because the incision is minimal, there is less tissue and muscle cut with the scalpel, resulting in a more positive experience for the patient. "The typical in-hospital stay for conventional hip replacements is four to five days," Dr. Landon explained. "This new, minimally invasive procedure should allow us to reduce the in-hospital stay by at least a day. More importantly, you can see in the patient's face that it hurts less. That adds up to a quicker, less painful recovery and a much more positive experience for the patient."

First performed in the 1960's, hip replacement operations are highly successful in relieving pain and restoring movement. While there have been many advances in the design and construction of artificial hip joints over the past 42 years, minimally invasive surgery represents the first major change in instrumentation and surgical technique. Thanks to smaller instruments with fiber optic lights, Dr. Landon and the other surgeons who are offering this advanced technique can insert the implant through a tiny incision. The implant hasn't changed, but the incision is much smaller, helping to reduce pain and bleeding and speeding up recovery.

Surgeries Top 168,000 Annually in U.S.

More than 168,000 total hip replacements are performed each year in the United States, according to the American Academy of Orthopaedic Surgeons. The first minimal incision hip replacement surgery was performed in Chicago, Ill., in 2001. Since that time, minimally invasive hip replacements have been offered at a few medical centers around the country. Dr. Landon is one of the first physicians to offer this pioneering procedure in Houston.

The first patient who opted for the minimally invasive procedure was a woman in her late 60s who sought relief from her arthritic pain. Another patient had a minimally invasive hip replacement and a conventional knee replacement on the very same day. Dr. Landon recently used the minimal incision technique for a partial implant in an elderly patient who had a fractured hip.

Patients "Get Back on Their Feet" Sooner

"Traditional replacements are highly effective at easing pain and restoring function," Dr. Landon explained. "However, pain and swelling after surgery slow recovery. This new technique is a refinement of the hip replacements I have been performing for 25 years. It's another tool we have to help our patients get back on their feet and back to their lives in a minimally disruptive way."

Dr. Landon predicts that one day these minimally invasive procedures will become the standard way to do a hip replacement. Right now, there are just a few physicians who have the expertise, knowledge and instrumentation to offer this alternative to their patients. The surgical suite at St. Luke's Episcopal Hospital, where Dr. Landon performs his implants, is fully equipped and staffed to provide this procedure.

How Hip Implants Work

Medications and walking aids may not be enough to ease the pain for someone whose hip has been damaged by arthritis, a fracture or other conditions. The only way to enjoy everyday activities may be to replace the diseased hip joint with an artificial joint, which is generally constructed of titanium. Hip implants come in different sizes and configurations to adjust to various body sizes and needs. However, all implants have three characteristics in common: 1) They are biocompatible, which means the body will not reject the implant; 2) they are resistant to corrosion and wear; and 3) they are strong enough to take the stress of weightbearing loads without breaking. "The exact size and device we use will depend on many factors, such as age, bone quality, or activity level," Dr. Landon noted.

"Best Outcome for Patient" Is Top Priority

Not everyone is a candidate for minimally invasive hip replacement surgery. "We evaluate each case on an individual basis," Dr. Landon explained. "Our goal is to provide the best outcome for the patient, whether we use conventional surgery or minimally invasive surgery."

For those patients whose situations are appropriate for the minimal incision hip replacement, the early results are extremely gratifying. "They are up and on their feet -- back to work or back to their normal everyday routines -- in a much shorter time than with conventional hip replacements," Dr. Landon said. "Clearly, this is one more advanced alternative we can offer to patients undergoing or considering hip replacement."