Michael L. Swank, MD, and Martha R. Alkire, CNP.
Bulletin of the NYU Hospital for Joint Diseases. June 2009. Vol. 67. No. 2. Pp.113-115.
In this study, Dr. M. L. Swank performed an equal number of THR and hip resurfacing procedures and compared the results in his patients. Over time, he was able to use a smaller incision with less disruption of the surrounding soft tissues. Early surgeries used a 4.5-inch long incision, reduced by almost a full inch. The THR was possible with a smaller incision (two inches).
By the end of the study, Dr. Swank was able to avoid dislocating the joint by splitting the gluteus maximus muscle and using the gluteus minimus to form a pocket. The head of the femur could be slipped into that pocket to perform the procedure. A similar approach was used to perform an equal number of THR. Although the hip was dislocated in order to cut off the femoral head and replace it, the resection was done under the skin. Doing it this way made it possible (in both the resurfacing and the THR) to access the head of the femur without cutting through all of the soft tissues.
Those results were evaluated using pain, function, and complications as the main benchmarks of success. Pain was equally improved in both groups at the first post-operative evaluation point (three months). Over time, the joint resurfacing group had better overall pain scores compared with the total hip group. Likewise, less pain translated into better function for all patients. Before surgery, the patients who had a THR had the lowest scores for function, so they had bigger before and after changes in function.
In this study, there were a few problems in both groups but no trends or major complications stood out.
Dr. Swank concluded that it is possible to perform hip joint resurfacing with a minimally invasive technique. With less soft tissue damage and less torque on the femoral head, results were equal to and even improved over THR. This benefits younger, more active adults in need of a hip replacement but too young for that much bone loss. With very few complications and a rate that didn’t exceed the one for THR, hip joint resurfacing using a minimally invasive approach is both safe and effective in the hands of an experienced surgeon.