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General Joint Surgery Information
Minimally Invasive Surgery —
It's Not Just a Smaller Scar
There has been a great deal of information on TV, in magazines,
and on the internet concerning "minimally invasive"
hip and knee surgery. Do we do minimally invasive surgery? Yes,
and we have been doing it for several years. About 3 years ago,
Texas Center for Joint Replacement designed the Rapid Recovery©
Hip and Knee for patients who want this kind of surgery. We
have the most experienced surgeons in North Texas for minimally
invasive total joint surgery. We have several years experience
with the Rapid Recovery© Total Hip and Rapid Recovery©
partial knee. The Rapid Recovery© Total Knee will follow
soon. Here is the "low-down" on quicker total joint
surgeries.
Texas Center for Joint Replacement has pioneered several techniques
designed to improve recovery from total joint surgery. This
process began even before the current focus on shorter recovery
times. We were the first in the area to close knee incisions
with the knee bent to give patients more flexibility right after
surgery. We also were the first to recognize the "wellness"
of the patient as a whole-he or she may have a bad joint but
is not "sick", and recovery can begin the day after
surgery. This concept moved patients back home much faster than
previous programs, and most of us do recover better in our own
home environment.
There is much talk about one and two day stays for total joint
surgery. Hospital stays are getting shorter and shorter. However,
there are inherent risks. We prefer to keep our patients in
the hospital a few days after surgery, not because the joint
needs protecting, but because other body systems, notably the
digestive system and urinary system have been stressed by the
surgery and we want to make sure they are functioning before
you leave the hospital. It is also easier to establish control
of pain in the hospital. So hospital stay is determined by the
needs of the individual, not the "plan".
Feature |
Traditional Total Joint
Surgery |
Rapid Recovery Program |
Length of Stay |
4-5 days |
3-4 days |
Implant |
Mallory-Head Metal on Metal (hip) AGC, Vanguard (knee)
|
Mallory-Head Metal on Metal (hip) AGC, Vanguard (knee) |
Incision |
6-10 inches |
One 4 inches, or two 2-3 inches |
Return to Active |
4-6 weeks |
2-4 weeks |
Length of Surgery |
1-2 hours |
2-3 hours |
Regular total joint surgery requires a longer rehabilitation
not because the implant is weak, but because the muscles and
tendons around the implant have been weakened by the surgery.
These soft tissues have to be cut or stretched to allow the
surgeon access to the joint. Over the years, doctors have tried
various approaches to the knee and hip to minimize damage to
the surrounding tissues. Each approach has its own set of advantages
and limitations and its own proponents among top surgeons. In
minimally invasive surgery the choice of approaches is compounded
by the choice of one or two incisions. Both techniques have
their champions and no one knows at this point which is better.
The surgery's success depends on the surgeon's ability to see
or feel "landmarks" that let him know that the implant
is in the right place.
Another variable in choosing which surgery to have: In minimally
invasive surgery, sometimes new implants and instruments have
been designed to accommodate the smaller incision. The success
of these designs is unknown.
What the Rapid Recovery program does is combine the least damaging
approach with an implant that has been proven to be long-lasting.
The choice to use an existing implant eliminates one unknown
from the picture. We know that our implant design is durable.
The ideal candidate for this type of surgery is someone who
is not excessively overweight, has a problem limited to arthritis
and not involving the architecture of the joint, or the surrounding
muscles and tendons, and who is vigorous enough to be able to
do the aggressive therapy to get back on his/her feet in less
time. Does that mean that we will never do any other patient
than one who meets the above description? No. We will take each
case as it presents itself. Programs can be developed for most
individuals. Still, there are some patients who would clearly
not benefit from this type of surgery. The doctor can explain
why regular total joint surgery might be your best choice.
After 40 years of joint replacement, the orthopaedic community
has learned that implant design and surgeon's skill are the
most important predictors of successful total joint surgery.
Whatever new techniques are developed, no one wants to go from
a successful strategy to one less successful-no matter what
the public demands. Nor is it logical to choose a surgeon with
little or no experience in this field simply because he will
do "minimally invasive" surgery. With that in mind,
it is clear that minimally invasive surgery is not for everyone,
or available from any source.
In the long run, it is not how big the scar is, or how long
you are restricted from your daily routine, but how long the
implant lasts and how comfortable you are with your new joint.
While it will take 15-20 years to get a definitive answer on
minimally invasive surgery compared to regular total joint surgery,
it is believed by most practitioners that the benefits of less
invasive surgery are limited to the shortened recovery time
and will not affect the outcome over the life of the implant.
A word of caution: Poorly designed or poorly inserted implants
may not last as long as regular ones, so choose your surgeon
carefully.
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