Minimally Invasive Revision THR-Anterior Approach

Revision Total Hip Replacement is a catch-all term that can mean anything from a simple change in the plastic liner of the implant, to full reconstruction of the femur and acetabulum with massive implants and bone grafting.   All patients who have had total hip replacement can potentially wear out the prosthesis.   Other indications for revision include osteolysis, a condition where the bone is dissolved, dislocation or infection of the prosthesis.

Traditionally, revision hip replacment surgery has been a major undertaking through either the lateral or posterior approach.   Both of these approaches, while very effective for performing large surgeries, operate through the muscle and therefore can compromise muscle strength.

With the advent of anterior approach hip replacement surgery, the possibility of minimally invasive revision surgery has become a reality.   The anterior approach accesses the hip between muscles rather than through them, and thus can potentially preserve more normal muscle function.

Minimally Invasive Revision Hip Surgery

The key to successful minimally invasive revision hip replacement is a careful preoperative assessment to insure that a minimal operation will truly solve the problem. For example, a patient may be suffering with hip dislocations due to a wearing out of the plastic liner of the hip socket. This would be a great indication for a minimally invasive revision. On the other hand, that same patient could be dislocating due to malposition of the femoral stem. In this case, the problem cannot be corrected with a minimal approach. The patient will have a much better result and a quicker recovery with a lateral or posterior approach.

Our approach to each patient with implant problems includes a detailed history and physical examination followed by a comprehensive workup to pinpoint the source of the problem. Once the nature of the problem is clear, we can develop a plan to resolve the problem with as little trauma and stress to the patient as possible

Case 1:
Patient had undergone a resurfacing arthroplasty due to bone collapse. Seven years later, patient was experiencing severe groin pain due to wear of the cartilage in the hip socket

Patient underwent a minimally invasive revision hip replacement via and anterior approach and was able to walk out of the hospital unassisted two days after surgery.

Case 2:
Patient developed severe groin pain 3 years after a total hip replacement done with a posterior approach and a 12 inch incision. Xrays show a loose socket component that has spun around in the bone

Patient underwent and minimally invasive acetabular revision via an anterior approach and a 4 inch incision.