View source for Minimally invasive hip resurfacing

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'''Minimally invasive hip resurfacing''' (MIS) is a total or partial [[hip]] surgery that can be carried out through an incision of less than 10&nbsp;cm (4 inches) without imparting great forces on the [[anatomy]] or compromising component positioning.<ref name="comis">Comis Orthopaedics website</ref>
The modified posterior MIS approach to hip resurfacing and [[total hip arthroplasty]] (hip replacement) displays a host of advantages to the patient:
# Less post-operative pain
# Less [[soft tissue]] damage and pressure on muscle fibres.
# Shorter hospital stay
# Lower blood loss
# Smaller incision
# Quicker return to work and functional activities<ref>Orthopaedic product news, Jan 2008 issue</ref>
==Technique==
The process of shortening the operative field (mini-incision) for hip resurfacing from the conventional open approach (15–30&nbsp;cm), to a mini-incision approach (7–15&nbsp;cm) has been well documented in the realm of hip surgery.<ref>OPN may issue 2008</ref>
It has been suggested by some surgeons, however, that in doing this one runs the risk of implanting the components incorrectly, especially the [[acetabular]] component.<ref name=autogenerated1>McMinn Centre website</ref> It has also noted that during femoral head reaming (drilling of the femoral head) with the surgical site being so small, the conventional instruments can damage the soft tissues.{{citation needed|date=February 2022}}
Having accepted this, the essential criterion for minimally invasive hip resurfacing are:
# An implant designed for MIS delivery
# MIS instruments for tissue protection
# Specialised instrumentation for femoral neck targeting, acetabular reaming, acetabular impaction and [[retractor (medical)|retractor]]s that are soft tissue friendly<ref>Mr.G.S.Chana, www.minimalinvasivehip.com</ref>
== History of minimally invasive hip surgery ==
Minimally invasive techniques for [[total hip arthroplasty]] (THA, or hip replacement) have been well described by various authors including:
* Richard Berger: "2 incision" technique + [[fluoroscopy]].
* Thomas P.Sculco: posterior approach.
* Innsbruck (Prof.Nolger): Direct anterior.<ref>specialistsupersite.com - article entitled "Which approach is better for mini-THA? posterior or 2 incision?"</ref>
Some MIS approaches for THA have been largely abandoned by surgeons, most especially Richard Berger's approach.<ref>Mr G.S.Chana, presentation at Fairlawns, Sutton Coldfield, 31 March 2008)</ref>
None of the above approaches offer a fluoroscopy-free approach to Minimal Invasive Hip Resurfacing. The only documented approach for minimally invasive hip resurfacing, having accepted the definition above, is that of Mr.G.S.Chana<ref>presentation on MIS resurfacing, Gian Sagar Medical College, India, March 2008</ref> of the [[Royal Orthopaedic Hospital]], Birmingham, UK.<ref>[[British Orthopaedic Association]] Handbook 2008</ref>
Mr.G.S.Chana, the creator of the MIS reamer handle and the Chana Targeting Device has proved that it is possible to perform hip resurfacing through an incision of 6.5&nbsp;cm's without macerating the soft tissues and incorrectly implanting the acetabular cup.<ref name="comis" />
== Conventional hip resurfacing today ==
Conventional hip resurfacing techniques were created as an alternative to total [[hip replacement]], whereby only the diseased cartilage and a small surrounding area of the femur are removed, to be replaced with new surfaces.<ref name="comis" />
Although [[hip resurfacing]] has been around for some 40 years, the contemporary metal on metal bearing hip resurfacing has only increased in popularity amongst surgeons and patients in the past decade.<ref>{{Cite web|url=http://www.orthorogerson.com/Hip-Resurfacehistory.htm|archiveurl=https://web.archive.org/web/20081006151411/http://www.orthorogerson.com/Hip-Resurfacehistory.htm|url-status=dead|title=John S. Rogerson, Orthopaedic Surgeon - Hip Resurfacing: History Main Menu<!-- Bot generated title -->|archivedate=6 October 2008}}</ref> Health-related [[quality of life]] measures were markedly improved and patient satisfaction was favorable after hip resurfacing arthroplasty.<ref>{{cite journal  |vauthors=Koutras C, Antoniou SA, Talias MA, Heep H |title=Impact of Total Hip Resurfacing Arthroplasty on Health-Related Quality of Life Measures: A Systematic Review and Meta-Analysis. |journal=J Arthroplasty. |date=19 May 2015 |pmid=26067708 |doi=10.1016/j.arth.2015.05.014 |volume=30 |issue=11 |pages=1938–52}}</ref>
Hip resurfacing has been welcomed by a number of surgeons globally, but others have met the technique with a certain degree of hesitation due to a number of potential disadvantages:
{|
|- style="text-align: left;"
! Hip Resurfacing
! Total Hip Replacement
|-
| + Bone preserving
| + Long-term results positive
|-
| + Beneficial to younger, more active patients
| + Less restrictions on patient suitability
|-
| + Better prospects for future revision
| + Comparatively better range of motion
|-
| + Best replicates pre-existing anatomy
| - Complicated revision process
|-
| - Larger incision, and higher risk of fracture
| - Life expectancy of ≥ 30 years post operatively will require revision<ref name="comis" />
|}
Incisions for hip resurfacing (posterior approach) have been well documented to stretch in excess of 20&nbsp;cm in length. Hip resurfacing has been described as a more complicated procedure in comparison to [[hip replacement]], and the operative technique described by Derek McMinn FRCS Ed, for posterior hip resurfacing shows operative incision similar to the ones mentioned earlier.<ref name=autogenerated1 />
==References==
{{reflist}}
[[Category:Surgical procedures and techniques]]
[[Category:Minimally invasive surgery]]