Minimally Invasive Surgery & Joint Replacement
The newest evolution in joint replacement surgery focuses upon improving patient recovery. For the past four decades, joint replacement surgeons have studied methods to improve fixation, alignment and durability of artificial components used to replace joints badly damaged by arthritis and injury. Along the way, they have become so adept that satisfaction and success rates typically range between 95-97%. In fact, in terms of the impact upon quality of life, no medical intervention ever has been as successful as a hip or knee replacement, not even open heart surgery.
However, despite the improvements made by surgeons and engineers, patients have asked for even more. For example, certain recreational activities can be difficult to engage in after hip or knee replacement because of limitations in flexibility imparted by the artificial parts. Similarly, younger, more active patients frequently require joint replacement, and the original components were unable to withstand the pounding these patients placed upon the parts. As a result, newer components have been designed to meet the needs of these special patient populations. So far, the short-term results are in, and they have been encouraging.
Now, patients want to get better faster. Typically patients spend 3-5 days in the hospital, up to 2 weeks in rehabilitation facilities, and up to 3 months regaining their muscle strength and eliminating their limp. For patients with busy and active lifestyles, as well as those who need to return to work, that time-frame is too long. Minimally invasive solutions provide a surgical approach that attempts to meet the needs of these patients.
In terms of hip replacement, mini-incision surgery and two-incision surgery are the newest procedures. Mini-incision surgery utilizes special instruments to perform hip replacement through a 3-4 inch incision, instead of the traditional 8-10 inch incision. The advantage is less pain, less bleeding, faster recovery, shorter hospital stays, and a more cosmetic scar. Two incision surgery uses a non-muscle cutting approach to implant components through two 1.5-2 inch incisions. An incision in the front of the hip allows placement of the socket, while an incision in the buttock allows implantation of the femoral stem. Advantages include minimal pain, the ability to stand and walk on the same day as surgery, 1-2 day hospital stays, and getting rid of crutches within two weeks.
Similarly, knee replacement can be performed through a mini-incision approach or a Quad(muscle)-sparing approach. In the mini-incision total knee replacement, a 3-4 inch incision is utilized rather than the traditional 10 inch incision. Specialized instruments allow surgeons to use standard knee replacement components, but with the benefit of less pain, less tissue damage, less bleeding, shorter hospital stays and faster recovery. In the Quad-sparing technique, no cuts are made in any tendon or muscle (such as the quadriceps with traditional and mini-incision total knee replacement), enhancing each of the benefits listed above.
Currently, a very limited number of surgeons have been trained or have become experienced with these procedures. At this time, surgeons still use components with a long track record for durability. Short-term results indicate that the risks and complications are the same as with traditional joint replacement. Long term results regarding benefits and durability are not yet available. It is important for patients to realize that not everybody is a candidate for these procedures, and that a thorough evaluation by a trained MIS surgeon is required to determine whether one qualifies.
Dr. Shah is uniquely qualified to do these procedures based on his fellowship training in MIS surgery from Massachusetts General Hospital, Boston, MA.