Minimally invasive total hip replacement

NICE have stated that:

• with respect to minimally invasive total hip replacement - there appears adequate to support the use of this procedure provided that normal arrangements are in place for clinical governance, consent and audit
• a traditional hip replacement involves accessing the joint through a large incision (approximately 20-30 cm in length) with division of muscles, ligaments and tendons. Several different approaches may be used
• in contrast for a minimal invasive hip replacement
  • minimally invasive total hip replacement is carried out with the patient under general or epidural anaesthesia, using an approach that aims to avoid damage to the muscles and tendons around the hip joint
    • a single incision of 10 cm or less in length is made. Alternatively, incisions are made at the front and back of the hip
    • division of muscles may be necessary but is less extensive than in standard approaches. Specially designed retractors and customised instruments are typically used to expose the hip joint, prepare the acetabular socket and the femur, and insert the prosthesis. Fluoroscopic guidance and computer-assisted navigation tools may be used to aid positioning of the implant
      • a range of different prostheses are available for this procedure, which may be cemented or uncemented

NICE state that prostheses for total hip replacement and resurfacing arthroplasty are recommended as treatment options for people with end-stage arthritis of the hip only if the prostheses have rates (or projected rates) of revision of 5% or less at 10 years (2)

Reference:

1. NICE. Minimally invasive total hip replacement. Interventional procedures guidance IPG363. Published October 2010
2. NICE. Total hip replacement and resurfacing arthroplasty for end-stage arthritis of the hip. Technology appraisal guidance TA304. Published February 2014