The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Minimally invasive total hip replacement, Interventional Procedures Guidance no. 363.
This replaces the guidance on Single mini-incision hip replacement (IPG152, January 2006).
Please click here to be directed to the current NICE guidance.
The most common indication for a total hip replacement is degenerative arthritis (osteoarthritis) of the hip joint. Other indications include rheumatoid arthritis, injury, bone tumours, and avascular necrosis of the femoral head.
Conservative treatments for arthritis include weight loss, analgesic or anti-inflammatory medication, and physiotherapy. If conservative treatments fail, a hip replacement may be indicated.
A conventional hip replacement may be performed through several approaches, all of which involve making a large incision (20 to 30 cm) and cutting through the muscles, ligaments and tendons to access the hip joint. The head and neck of the femur is removed and replaced with a metal ball and stem. The surface layer of the socket is removed and an artificial socket is attached to the pelvis. Cement may be used to bond the artificial joint to the existing bone or the artificial parts may be made of a porous material that allows bone to grow into the pores to hold the parts in place (uncemented procedure).
Minimally invasive techniques have been developed that use specially designed instruments to insert standard prostheses through either one or two smaller incisions.
Minimally invasive one-incision total hip replacement may be performed under general or epidural anaesthesia. The same approaches are used as in traditional hip replacement surgery but the incision is much shorter (usually 10 cm or less in length). In general, specially designed retractors and customised instruments are used to expose the hip joint, prepare the socket and to insert the prosthesis. Fluoroscopic guidance may be used to aid positioning of the implant and computer-assisted navigation tools have also been developed. Some dissection of muscle is necessary but to a lesser extent than in the traditional approach. The same prostheses that are used for a traditional hip replacement are used and these may be cemented or uncemented.