Single mini-incision surgery for total hip replacement
Summary
The National Institute for Health and Clinical Excellence (NICE) issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on minimally invasive two-incision surgery for total hip replacement in January 2006.
NICE has reviewed this guidance and is reassessing the procedure along with minimally invasive two-incision surgery for total hip replacement. New guidance will be published as a result. Until the new guidance is published the NHS should continue to follow the recommendations in the guidance below. For all developments relating to the updated guidance which is currently in development, please click here.
Description
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.
OPCS code:
Details
Surgical procedures
British Hip Society
British Orthopaedic Association
Contact details:
(for general enquiries or comments)
(for procedure specific enquiries or comments)
ip@nice.org.uk
Interventional Procedures Programme
National Institute for Health and Clinical Excellence
MidCity Place
71 High Holborn
London
WC1V 6NA
