Minimally Invasive Hip Replacement

What is Minimally invasive hip replacement?

The traditional surgical approach to total hip replacement uses a single, long incision to view and access the hip joint.

A variation of this approach is a minimally invasive hip replacement procedure in which one or two shorter incisions are used.

The goal of using shorter incisions is to reduce pain and speed recovery.

During any hip replacement surgery, the damaged bone is cut and removed, along with some soft tissues. In minimally invasive hip replacement surgery, a smaller surgical incision is used and fewer muscles around the hip are cut or detached. Despite this difference, however, both traditional hip replacement surgery and minimally invasive surgery are technically demanding and have better outcomes if the surgeon and operating team have considerable experience.

Why is the surgeon experience so important with Minimally invasive hip replacement techniques?

Minimally invasive hip replacement surgery should be performed by a well-trained, highly experienced orthopedic surgeon.
Implant selection and placement is critical to long term success and this is a very specialized procedure.

Minimally Invasive Anterior Approach – Preserving Soft Tissue

MiniHip™ is an ideal implant for use with a direct anterior approach hip replacement, soft tissue sparing procedure, as it follows the natural anatomy by going ‘round the corner’ of the calcar.
Direct anterior approach patients have reported earlier discharge and return to an active life as compared to patients who receive the posterior approach.
The MiniHip™ Bone Preserving Hip Replacement implant and MIAA™ instrumentation systems are ideally suited to direct anterior, helping to facilitate patient recovery and a faster return to activity.

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The Best Hip Replacements

Short Stem vs Standard Hip Replacement

In general, short stem hip replacement implants are designed to require less removal of bone.
This serves a dual purpose of preserving the bone for future revision surgery while providing a postoperative state closely mimicking the originally functioning hip joint.
Preserving the bone will certainly be important for “younger more active patients” who may need further surgeries.
Specifically, preservation of femoral neck and a properly designed short stem implant allow for correct stress distribution and avoid complications.
The short stem hip replacement implant allows for the normal physiologic state of load transfer throughout the hip joint.
Several Un-cemented or cementless short stem hip replacement options have been designed.

Short Stem Bone Sparing Hip Replacement

Hip Replacement Patient demographics and expectations have changed, Short Stem Bone Sparing Hip Replacement serves that need.
Being younger, more active and wanting to return to their normal way of life quicker and without compromise,
these patients require an implant that overcomes the limitations of conventional hip replacement.Bone Preserving Hip Replacement

MiniHip™ Short Stem Bone Sparing Hip Replacement is designed to give patients all the advantages of a traditional total hip replacement with the added benefit of preserving the natural anatomy, offering a solution that is an ideal intervention for a patient requiring treatment options into the second, third and fourth decade.

MiniHip™ Short Stem Bone Sparing Hip Replacement is designed to provide the bone preserving benefits of hip resurfacing with the stability of traditional total hip replacement

  • Typically mid-neck resection, defined from the centre of rotation
  • Trochanter conserving, neck preserving and diaphyseal sparing
  • Promotes physiological loading

MiniHip™  Short Stem Bone Sparing Hip Replacement has shown 99.5% survivorship at 3 years for aseptic loosening and has been awarded 3A rating for clinical excellence by the Orthopaedic Data Evaluation Panel (ODEP).

MiniHip™ Bone Sparing Hip Replacement is designed to preserve significantly more bone stock in the femoral neck, trochanter and diaphyseal region in comparison to other short and conventional stems, helping to promote more natural, physiological loading.Bone Preserving Hip Replacement

1. Trochanter conserving MiniHip™ is designed to follow the natural anatomy: there is no lateral flare and the entry point avoids the greater trochanter.

3. Neck preserving MiniHip™ neck resection is intended to preserve the neck and calcar to assist in promoting more natural physiological loading, unlike conventional Total Hip Replacement.

2. Diaphyseal sparing The length and design of MiniHip™ allows for more bone preservation of the medullary canal than traditional Total Hip Replacement. In addition, the distal tip of MiniHip™ Bone Preserving Hip Replacement is polished to reduce the risk of an increase in bone mineral density from occurring at this point.

Minimally Invasive Anterior Approach – Preserving Soft Tissue

MiniHip™ is an ideal implant for use with a direct anterior approach hip replacement, soft tissue sparing procedure, as it follows the natural anatomy by going ‘round the corner’ of the calcar.
Direct anterior approach hip replacement patients have reported earlier discharge and return to an active life as compared to patients who receive the posterior approach.
The MiniHip™ Bone Sparing or Bone Preserving Hip Replacement implant and MIAA™ instrumentation systems are ideally suited to direct anterior, helping to facilitate patient recovery and a faster return to activity.

Restoring Biomechanics

MiniHip™ Hip Replacement offers a unique way of restoring biomechanics for different patient anatomies.
MiniHip™ is a CT based design and is not constrained in its placement by a conventional, intrusive lateral profile.
This provides a unique solution to restoring the biomechanics of multiple patient anatomies.

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What about the ball and socket materials and technology?

Pressfit Hip Replacement designs direct forces to the rim of the cup which minimizes the potential for miss-alignment when seated in the socket.
A new generation in hip replacement innovation and pioneering, cementless cup technology, is designed to maximize fixation and articulation size.
Ceramic hip implants are among the newer types of prostheses being used for hip replacement, offering greater resistant to damage and smooth movement of the joint.
Ceramic hip replacement devices appear to cause far less inflammation and few, if any, pseudotumors.
This appears true whether the device is all-ceramic, ceramic-and-metal, or ceramic-and-plastic.
Many surgeons today consider them to be an improvement over traditional metal-and-plastic implants in which the deterioration of plastic can lead to the gradual buildup of debris around the joint.
There are many types of total hip replacement available and many bearing material options as well as press fit options.

Bearing Material options available with different bearing surfaces. These are:

  • Metal-on-Polyethylene: The ball is made of metal and the socket is made of plastic (polyethylene) or has a plastic lining.
  • Ceramic-on-Polyethylene: The ball is made of ceramic and the socket is made of plastic (polyethylene) or has a plastic lining.
  • Metal-on-Metal: The ball and socket are both made of metal.
  • Ceramic-on-Ceramic: The ball is made of ceramic and the socket has a ceramic lining.
  • Ceramic-on-Metal: The ball is made of ceramic and the socket has a metal lining

An orthopaedic surgeon should determine which hip implant will offer the most benefit and least risk for each patient.
When making a recommendation, orthopedic surgeons should consider several factors such as the patient’s age, weight, height, activity level, and cause of hip pain.
Hip surgery may involve total hip replacement or it may involve hip resurfacing.

Hemispherical titanium shell designed for excellent initial press-fit and long-term stability.
Biomimetic cementless coating technology for cementless hip replacement.

  • Calcium phosphate (CaP) coating with a microcrystalline structure
  • Maintains substrate surface roughness, providing a large area for osseointegration
  • Room temperature electrolytic deposition process

Porous Metal Technology

The goal to build a structure that directly mimics the architecture of human bone. This process facilitates tissue in-growth and implant stability.

ECiMa™ Vitamin E-enriched Hip Bearing

The next generation vitamin E-enriched technology, the most advanced polyethylene of its kind, providing a high performance alternative to hard bearings.
Vitamin E is blended and consolidated with UHWPE powder providing uniform distribution of the antioxidant.
Cold Gamma Irradiated to create cross links for improved wear resistance of the material.

Modular Neck Hip Replacement

Restoring leg length, joint stability, and range of motion involve distinct surgical challenges.
The Modular Neck Hip Replacement introduces a system of modular stem and neck components designed to help the surgeon restore the hip joint center by addressing leg length, offset, and version independently.
The resulting array of neck options efficiently targets a broad range of male and female patient anatomies.

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What about Hip Joint Resurfacing?

During hip resurfacing surgery, the femoral head is not removed. Instead the femoral head is trimmed and capped with a metal covering. Any damaged bone and cartilage within the socket are removed and replaced with a metal shell. In hip resurfacing surgery, both components are made of metal.
Anterior Minimally Invasive Surgery
The Anterior Minimally Invasive Surgery method requires a completely matching system of operating table with leg holder, instruments and the very best implants. During the operation, the anterior musculature beneath the small skin incision is merely displaced, but not severed. This considerably reduces the risk of damaging muscles, tendons, vessels or nerves. The special leg holder ensures that, despite the relatively small “field of vision” for the surgeon, the joint to be operated on can be optimally presented allowing good access to all areas. This protection of the soft tissues significantly reduces the danger of bleeding or inflammation. In addition, the abductors, the muscle group at the side, which is important for stabilizing the pelvis, is not affected. This means that muscle function can be achieved quickly after the operation which greatly increases recovery. Normally, an immediate full weight bearing of the new joint is already possible on the day of the operation.
The risks of a dislocation of the joint because of separated muscles or tendons are practically eliminated. And the frequently observed phenomenon of a bad gait or of a limp is also avoided. Other so-called minimally invasive entries (e.g. a rear, side, or combined entry) may also be characterized by relatively small skin incisions. However, in these interventions, muscles or tendons can often be impaired just as badly as with conventional methods. Only the externally visible scars are smaller, and the internal healing requires just as much time and rest as with conventional methods. Overall, the use of the Anterior Minimally Invasive Surgery method allows the re-establishment of the joint function to be accelerated significantly. All known risks of a hip prosthesis operation are reduced considerably. Normally, this makes it possible to take up all professional activities more quickly again to their full extent and also to participate in sport.

The Best Hip Replacement Surgeons

Dr. Stephan Tohtz is a specialist in modern hip replacement techniques and other corrective surgeries.
With over 20 years of surgical experience in trauma and orthopedic surgery he now holds the title of Chief Physician for Orthopedics and Trauma at HELIOS Hospital, Berlin.
His extensive experience with a full range of globally available hip replacement technologies makes him an excellent choice for your hip replacement surgery.

Why is the surgeon experience so important with Minimally invasive hip replacement techniques?

Minimally invasive surgery should be performed by a well-trained, highly experienced orthopedic surgeon.
Implant selection and placement is critical to long term success and this is a very specialized procedure.

The Best Hip Replacement Hospital

What about the facility?

While many hospitals will do a Hip Replacement Surgery the facility you choose is important.
Whenever you implant something into your body infection becomes a great concern.
One of the things we enjoy in Germany is a low overall rate of MRSA infection compared to much of the world.
In fact, Germany’s MRSA rate is about 2/5ths of the the US’s rate.
Then consider that we operate in a private, Orthopedic hospital.
This means no Emergency Room patients bringing in infections.
As a result, our MRSA rate in the hospital is essentially zero. Yes Zero!!

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