LAYTON — Surgeons at Davis Hospital and Medical Center are replacing hips with a new technique that promises less patient trauma and a shorter recovery time.
The minimally invasive anterior supine intramuscular approach is done by gaining access to the hip joint through a much shorter incision at the front of the hip instead of on the side or back, said Dr. Matthew Lyman, an orthopedic surgeon at Davis Hospital and Medical Center.
“One thing that patients don’t realize about the anterior supine intramuscular approach, or ASI, for total hip replacement is the importance of the S, or supine,” Lyman said. “The fact that the patient is supine (or on their back facing upward) makes a difference for several reasons. Most importantly, it makes it easy to use live x-ray in the operating room.”
With conventional hip replacement, the patient has to lay on a side, Lyman said. With all the positioning devices in the way and the patient being tilted a little bit forward or backward, it is incredibly difficult to get a quality x-ray.
“Secondly, with the patient supine, or laying on their back, the anesthesiologist has full access to the patient’s airway,” he said. “I have seen it happen once, several years ago in training, when the patient’s heart stopped beating and the surgery had to be stopped, the wound quickly stapled shut in the middle of the surgery and the patient was rolled supine to save the patient’s life. So having access to the patient’s airway makes the surgery slightly safer.”
According to the National Institute of Arthritis and Musculoskeletal and Skin Disease website, hip replacement surgery is done for a variety of reasons, including rheumatoid arthritis, osteonecrosis (a disease that causes the bone in joints to die), injury to the hip joint and bone tumors that break down the hip joint.
So far, Lyman has performed the surgery on 12 patients. During the procedure, the patient is sedated under general anesthesia and placed on the surgery table. X-rays are taken and the hip is prepared with an aseptic solution. From there, a four- to five-inch incision is placed over the hip and the muscles are parted and the replacement begins.
Lyman said this is an important difference in the surgery because the muscles are not cut. The use of X-ray is vital throughout the surgery to make sure the patient is precisely positioned and the new hip matches the other hip.
Risks include infection, fracture, wound problems, nerve injury, dislocation, failure of the components, anesthesia complications and leg length inequality. However, Lyman said, the ASI approach lessens some of these risks found with traditional hip replacement surgery.
After surgery, Lyman said patients are returning to their daily activities within weeks. Most patients are driving after about two weeks.
“The recovery of the patient in the first few weeks is improved with the ASI approach,” Lyman said. “They have an earlier return to activities, an easier time walking and less pain.”