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Minimally Invasive Hip Replacement - Hip Arthroplasty

Introduction
The hip is one of the most frequently replaced joints.  Osteoarthritis, a type of arthritis, is the main reason for hip replacement surgery.  Other conditions, including trauma, may also require the need for a hip replacement. 
 
Arthritis is a disease that causes joint pain, stiffness, immobility and swelling.  It can affect the cartilage and bone in the hip joint.  Cartilage is a very tough, shock absorbing material that covers the ends of many of our bones.  The cartilage forms a smooth surface and allows the bones in our joints to glide easily during motion.  Arthritis can cause the cartilage to wear away.  Loss of this protective lining can cause painful bone on bone rubbing. 
 
While the symptoms of hip arthritis may be tolerated with some medications and lifestyle adjustments, there may come a time when surgical treatment is necessary.  One type of hip replacement surgery is called Minimally Invasive Hip Arthroplasty.  Like traditional total hip replacement surgery, it involves removing the damaged portion of the hip and replacing it with artificial implants called a prosthetics.  These devices are a replacement for the natural joint and allow pain-free movement.
 
Minimally Invasive Hip Arthroplasty uses smaller incisions than traditional surgery.  This allows individuals to experience less pain, spend less time in the hospital, and have shorter recovery times.

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Anatomy
Our hip joint is a ball-in-socket joint.  Our thigh bone is called the femur.  The top of the femur is shaped like a ball.  It is called the femoral head.  Our pelvic bone has a cup-shaped socket that holds the femoral head in place and allows it to rotate during movement.  The cup-shaped socket is called the acetabulum.  The acetabulum and the femoral head form our hip joint.  Bands of strong tissue ligaments connect the femoral head to the acetabulum and provide stability.
 
The surfaces of the bones in the hip joint are covered with articular cartilage.  This is a strong smooth cover that cushions the ends of our bones and allows them to move easily.  The remaining surfaces of our hip joint are covered with synovial membrane.  This smooth thin tissue secretes synovial fluid that lubricates the joint and eliminates friction between the bones.
 
The hip is one of our body’s largest weight-bearing joints.  The primary function of the hip joint is to support the weight of our head, trunk, and arms.  The hip joint provides a base of support that allows us to hold our body upright when we sit or stand.  Likewise, it provides stability for our upper body while positioning the lower body for movement.  The hip joint allows our legs to move to the front and back and from side to side as we walk, run, and climb stairs.  It also allows our legs to rotate inward and outward.  We rotate our legs when we place our feet on the ground.  We angle our toes inward or outward for balance.

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Causes
Arthritis is a major cause of joint pain, stiffness, and swelling in the hip.  Arthritis can occur for many reasons, including aging, “wear and tear,” injury, disease, and developmental abnormalities in the hip structure.  There are over 100 different types of arthritis.  Osteoarthritis, Post-Traumatic Arthritis, and Rheumatoid Arthritis are types of arthritis that frequently develop in the hip.
 
Osteoarthritis is the most common type of arthritis and affects millions of Americans alone.  It tends to develop as people grow older.  Osteoarthritis can result from overuse of the hip during sports or work.  Post-Traumatic Arthritis can develop in individuals of all ages after a hip injury, such as a fracture.
 
Osteoarthritis causes the articular cartilage covering the end of the bones to gradually wear away, resulting in painful bone on bone rubbing.  Abnormal bone growths, cysts or spurs, can grow in the hip joint.  They add to the pain and swelling, while disrupting movement. 
 
Rheumatoid Arthritis is one of the most serious and disabling types of arthritis.  Rheumatoid Arthritis can affect people of all ages, but most frequently occurs in women and those over the age of 30.  It is an autoimmune disease that causes the synovial membrane to become inflamed.  This damages the articular cartilage and leads to pain and stiffness.
 
Traumatic Arthritis can develop after a severe hip injury or fracture.  A hip fracture can cause a condition called Avascular Necrosis.  This medical condition causes a lack of blood flow to the femoral head and leads to bone and tissue death.  Avascular Necrosis can cause articular cartilage damage, resulting in hip pain and stiffness.

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Symptoms
The main symptom of severe hip arthritis is dull and aching pain.  You may feel pain in your hip, groin, thigh, buttock, and sometimes in the knee.  Your pain may occur while you are moving or resting.  It may even keep you awake at night.  Your hip may feel stiff and swollen.  You may have difficulty moving or lifting your leg.  Your hip pain may eventually limit your everyday activities, including walking, stair climbing, and bending.  Medications and physical therapy may provide little relief from the pain of severe hip arthritis.

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Diagnosis
Your doctor can diagnose arthritis by conducting a physical examination.  You will be asked about your medical history, symptoms, and level of pain.  You will be asked to perform simple hip and leg movements to help your doctor assess your muscle strength, joint motion, and hip alignment.  Blood tests and other laboratory tests may identify what type of arthritis you have.
 
Your doctor will order X-rays to see the condition of your bones and to identify areas of arthritis, bone cysts, or bone spurs.  Sometimes the tissues that surround the hip joint or the condition of the bones do not show up on an X-ray.  In this case, your doctor may order Magnetic Resonance Imaging (MRI) scans or a bone scan.  An MRI is used to obtain more detailed images of the soft tissues.  A bone scan identifies the location of abnormal growths in a bone, such as arthritis.  A bone scan requires that you receive a small harmless injection of a radioactive substance several hours before your test.  The substance collects in your bones in areas where the bone is breaking down or repairing itself.  X-rays, MRIs, and bone scans are painless tests. 

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Surgery
As your arthritis progresses and becomes more severe, medication, rest, and physical therapy may fail to relieve your symptoms.  Your pain and immobility may cause you to limit your activities and lifestyle.  Hip replacement surgery is recommended when non-surgical treatments do not provide relief of your symptoms.  Minimally invasive hip replacement surgery allows for faster recovery and less trauma to the body than standard hip replacement surgery.
 
Minimally Invasive Hip Arthroplasty is an alternative to traditional total hip replacement surgery.  People who are smaller in size, younger, and healthy are the most appropriate candidates for this procedure, however doctors are performing it on a variety of patients.  Minimally Invasive Hip Arthroplasty is similar to traditional total hip replacement in that it involves removing the damaged joint and replacing it with an artificial one.  However, because the minimally invasive procedure utilizes one or more small incisions, the recovery process is much easier.
 
Minimally Invasive Hip Arthroplasty is most often performed as an inpatient procedure, although in some cases it can be an outpatient surgery.  The most common types of anesthesia for the surgery are general anesthesia or spinal anesthesia.  The general anesthesia will put you to sleep.  The spinal anesthesia will numb your body from the waist down, while you remain awake but sedated.  Your doctor will help you decide which anesthesia is best for you.
 
Minimally Invasive Hip Arthroplasty may use a single or a double hip incision surgical method.  With the single incision method, a three to six inch incision is made over the outside of the hip.  The double incision method involves making a two to three inch incision over the groin and a one to two inch incision over the buttock.  Your hip joint will be opened to allow your surgeon to remove damaged bone, cartilage, or connective tissue.  The femoral head and the cartilage or bone from the hip socket will be removed.
 
Your hip joint will be replaced with an artificial joint.  There are a variety of prosthetics, and your surgeon will choose the most appropriate one for you.  A highly polished strong metal ball will be implanted or attached to the top of your femur.  A durable socket made of plastic or plastic and metal will be attached to your bone with surgical screws or surgical cement.  The artificial joint will allow you to perform most of the pain-free movements that you used to be able to do.

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Treatment

A physical therapist will instruct you on the initial temporary movement restrictions that you will need to adhere to.  The movement restrictions will help prevent your artificial joint from dislocating and allow it to heal.  Depending on the surgical approach and extent of the surgery you may be asked to refrain from crossing your legs, bending your hips at more than a 90-degree angle, and pointing your feet inward or outwards.  

Your physical therapist will teach you how to safely exercise to increase the strength in your hip. At first, you will need to use a walker, crutches, or cane while standing and walking.  As you get stronger, your physical therapist will show you how to go up and down stairs.  Your exercises program will gradually increase to strengthen your hip and improve your endurance.  After hospitalization, you may continue with a home exercise program or outpatient physical therapy.  When your incisions are healed you may perform physical therapy exercises in a heated therapeutic pool.  The heat may help to relieve pain and stiffness, while the water provides you with support while exercising your joints. 

An occupational therapist can show you ways to dress and bathe within the range of your movement restrictions.  Your therapists can recommend durable medical equipment for your home, such as a raised toilet seat or a shower chair.  The equipment may make it easier for you to take care of yourself as you heal and help to prevent injury.

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Recovery
Your hospital stay may be as short as one to two days following your Minimally Invasive Hip Arthroplasty.  Some people may even go home on the day of the surgery.  Because only small incisions are used, you can expect less pain, less muscle involvement, and a faster period of rehabilitation than with traditional surgery.
 
You may need help from another person during the first few days at home.  If you do not have family members or friends nearby, ask your doctor about possible alternative arrangements. 
 
Compared to traditional surgery, Minimally Invasive Hip Arthroplasty is associated with less blood loss, lower risks of infection, less pain, shorter hospital stays, and a shorter recovery time.  You can also plan on being active sooner.  You may be able to return to your normal activity level within four to six weeks, instead of the three to four month recovery period that usually follows traditional surgery.

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Prevention
It is important that you follow your exercise program and adhere to safety precautions. You may resume many of your former activities following your Hip Arthroplasty.  You may have to change the way you do some activities, such as bending, to protect your new hip.  You will be advised to avoid high-impact sports, such as jogging, for the rest of your life.  High-impact sports or weight gain can put stress on your artificial joint, causing it to become loose or wear faster.
 
It is important to avoid falling.  Your therapists can suggest ways to prevent falls in your home.  This may simply mean removing throw rugs and making sure that your walking path is free of cords and clutter.  You should also continue to use the durable medical equipment as advised.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.