Minimally Invasive Anterolateral Hip Replacement
and the 24 Hour/Same Day Total Hip
OA Center for Orthopaedics
George M. Babikian, M.D.
Minimally invasive anterolateral total hip replacement is a remarkable new procedure pioneered in Germany that is now being performed by a select few surgeons in the US. By using this approach hip replacement can be accomplished with a minimum of surgical trauma by working between muscle groups with a single small incision. No detachment or splitting of muscle is required. This results in less pain, short recovery without need for typical restrictions post-operative, and remarkably rapid return to function. Dr. George Babikian at OA Centers for Orthopaedics was the first surgeon in Maine and is currently one of very few doctors in New England to perform this surgery. The procedure has near universal applicability, meaning that most all patients requiring hip replacement, regardless of age or body type, can benefit from this approach.
At OA we have coined the term "24 Hour Hip" to describe our procedure. By utilizing the minimally invasive anterolateral technique and a sophisticated anesthesia protocol, patients typically are up walking without significant pain within hours of surgery, take a minimum of pain medicine in the post-operative period (often just Tylenol), and are home comfortably the day after surgery without typical hip restrictions or precautions. Using the anterolateral minimally invasive approach over 90 % of our patients have comfortably gone home the day after surgery, and several have been discharged the day of surgery. The speed at which our patients return to function has been equally impressive, with return to physical labor often within a month and to desk type work in one to two weeks. Because we are using traditional implants, we believe the long term results will match or exceed traditional hip replacement, without concern for undiscovered problems associated with newer unproven technologies.
Each year 200,000 individuals in the US have traditional hip replacement. The typical length of stay in hospital is 3 to 4 days with significant use of pain medicine, not infrequently with discharge being to a rehab hospital, not home. Typical restrictions limit weight bearing and bending, sitting and turning for 6 weeks to 3 months.
Since March 2006, Dr. Babikian has performed approximately thirty minimally invasive anterolateral hip replacements each month with great success, minimizing the patients rehabilitation time and effort while maximizing recovery. Doubters have said "there is no free lunch", and while partially true, our results suggest we have been "paying too much for lunch" with the traditional hip replacement. Using true minimally invasive technique and minimizing soft tissue injury at surgery allows us to streamline the process for hip replacement patients that want to get back on their feet and back to living in the least possible time.
Total hip surgery is major surgery and requires preparation. You will meet with the anesthesiologist and have pre-operative labs and an EKG performed.
- You will be asked to come to our office for a pre-operative evaluation which includes x-rays, a history and physical, and to go over pre-operative pain management protocols.
- Pain management begins with pre-operative medication and continues post-operatively. This includes use of Celbrex, Acetaminophen, Lyrica, and a low dose narcotic pain medicine when needed. This protocol will be modified if you have allergies to these medicines.
- An advantage of this procedure is that there is no need for hip precautions since the muscle is left intact; therefore, no raised toilet seat or raised seat are needed.
- As with all hip replacements we use blood thinners to help prevent blood clots.
- Post-operative patients can resume activities as their symptoms dictate. The post-operative protocol includes the use of a walker (while putting full weight on the leg) for one week and the use of a cane for one week thereafter. Use of the cane may be longer as gait pattern dictates, but most patients are off the cane within two weeks after surgery.
Frequently Asked Questions
- What equipment will I need at home?
A walker and cane is needed, and a prescription will be provided at the time of your preoperative appointment.
- Does anyone come to my home after being discharged?
A home visiting nurse is arranged to come in to your home to do lab work if needed and a dressing change. A home physical therapist will come in for the first 2 weeks.
- When do my staples get removed?
Staples are removed 8-12 days from your surgery date.
- When can I shower?
You are able to shower after your staples are removed.
No bathing or submerging your hip for approximately 3 weeks after surgery and your incision is well healed.
- When can I drive?
At 2 weeks we will allow you to drive - but you should feel comfortable initiating driving. You must be off pain medication and should practice off the road prior to driving.
- When can I swim?
Swimming may resume 3 weeks after surgery when the incision is completely healed.
- When can I fly in an airplane?
There are no restrictions for flying after surgery; however, in the initial post-operative period we recommend some form of anticoagulation medication (blood thinner) to decrease the risk of blood clots.
- How long will I be out of work?
Resuming work is dependent on the type of occupation you have.
- Patients with sedentary jobs may be able to return 1-2 weeks after surgery.
- Patients with a physically demanding occupation may be able to return 4-6 weeks after surgery.
- When may I resume sexual activity?
Sexual activity may resume as soon as you are comfortable.
- How long after surgery will I need antibiotics prophylaxis prior to dental work?
You will need to take an antibiotic one hour prior to dental work for the rest of your life.
We ask that no dental work be done for the first 12 weeks after hip surgery.
- Am I candidate for minimally invasive anterolateral total hip?
The procedure can benefit almost anyone needing a hip replacement, young or old, healthy or sick. Early on we decided if it was a better operation for young healthy patients it was better for everyone, and have worked to apply it to all patients. Only patients with significant deformities or previous surgeries may not be candidates.
- What are the long term benefits?
These are under investigation, but our experience demonstrates an ongoing near nil risk of dislocation with no restrictions in motion. This is a significant advantage. Also evident is a much improved accuracy as regards leg length, it is hard to lengthen a leg too much in this procedure as the intact, uncut soft tissues will not allow it.
- Is it safe?
The minimally invasive anterolateral hip replacement is done under direct vision with good views of the entire acetabulum and femur as dictated by the stage of the procedure. After performing several hundred, we do not believe the approach adds any risk to hip replacement surgery.
- Will I need a transfusion?
Blood loss in the minimally invasive anterolateral hip replacement is typically low, with transfusion rates at less than one percent. As such we do not require pre-operative blood donation.
- Will I need therapy?
A physical therapist will work with you prior to discharge, teaching you to properly walk with a walker and to climb stairs. You will also be taught exercises to be done at home. A physical therapist will come to your home to help with exercise and gait as needed for the first two weeks. Outpatient therapy will then start based on your need and will be ordered at the six week postoperative mark.
- I don't live in Maine - can I have this procedure?
We have done the minimally invasive anterolateral total hip replacement for patients living as far away as Seattle, Washington. We can streamline the process, and if you can stay in the area for a week we can do your initial follow up prior to flying or driving home.
- Do I have to worry about blood clots?
DVT is a risk of hip replacement, but the early rapid mobility after minimally invasive anterolateral hip replacement seems to minimize the risk. Port-operatively you will be on low does coumadin for one week and the aspirin for 3 more weeks, unless you have a high risk of DVT by history.