Minimally Invasive Hip Replacement Procedure

Like traditional hip replacement, a minimally invasive hip replacement involves removing the arthritic (damaged) surfaces of the hip joint and replacing them with artificial ones. Learn about minimally invasive surgery and how it can differ from traditional surgery.

A Smaller Incision Is Used

Minimally invasive total hip replacements usually require 3- to 6-inch incisions, compared to 6- to 10-inch incisions for traditional hip replacement. These numbers are general ranges, and patients should talk to their surgeon about what to expect.

The Location of the Incision Can Vary

There is no single, correct way to perform minimally invasive hip replacement surgery. For example, where the surgeon cuts the skin and other soft tissue to get to the hip joint, sometimes called the surgical approach, can vary:

• Posterior (rear) or posterior-lateral approach uses an incision at the side of the hip, slightly to the back of the body

  See Anterior vs. Posterior Hip Replacement Surgeries

• Lateral (side) approach uses an incision at the side of the hip

   

• Anterior (front) approach uses an incision at the front of the hip

  See Deciding to Have an Anterior Hip Replacement

• Anterolateral approach uses an incision at the side of the hip, slightly to the front of the body
• Direct superior uses an incision at the top of the hip, to the side and slightly back of the body
• SuperPath approach uses about a 3-inch incision at the side of the body, just above the outer curve of the hip
• Two-incision approach typically involves a 2- to 3-inch incision over the groin and a 1- to 2-inch incision over the buttock

The posterior, lateral, anterior, and anterolateral approaches may also be used for traditional hip replacement (with larger incisions).

Different surgical approaches may have different potential advantages and risks. Over time, experts may learn that certain minimal approaches offer better outcomes than others. Currently, what type of surgical approach is recommended depends on the patient’s anatomy as well as the surgeon’s experience and preference.

See Choosing a Surgeon for Total Hip Replacement Surgery

Special Tools Are Needed

A smaller incision reduces the surgeon’s ability to see and work on the hip joint, so special tools are needed to:

• Access and dislocate the hip joint, removing the rounded head of the femur (thighbone) from its socket in the pelvis. The hip socket is called the acetabulum.
• Remove the damaged head of the femur.
• Prepare the acetabulum. The surgeon will use a tool called a hemispheric reamer to grind down and shape the acetabulum so it is ready to receive its prosthetic hip socket.

While the tools used for these steps are different, the actual steps are the same as for a traditional hip replacement.

The Artificial Hip Components Are the Same

The hip prostheses a patient receives is generally not dependent on the type of procedure used. The same types of hip components are used in both minimally invasive and traditional total hip replacement surgeries.

• An acetabular cup is placed into the reshaped hip socket. This cup may be made of a porous metal to allow the bone to grow into it over time, or it may be attached to bone tissue with special cement. The type of cup and how it is attached to the bone depends on the surgeon’s preference and the patient’s physiology.
• The surgeon puts a rounded acetabular insert/liner inside the acetabular cup. The insert is typically made of ceramic or plastic and will facilitate smooth movement within the new joint.
• The surgeon prepares the femur bone and inserts the prosthetic femoral stem into it. The femoral stem is a narrow, tapered metal shaft that fits several inches down inside the femur. The top of the stem is designed to hold a prosthetic ball, which will replace the femoral head.

The surgeon will take steps to ensure proper sizing and positioning of the components. The muscle and other soft tissues that were separated or retracted will be repaired and the skin incision will be stitched or stapled back together.

The Surgeries Take About the Same Amount of Time

The total surgical time is typically about 2 hours. While minimally invasive surgeries tend to take a little less time, the average difference is a matter of minutes—probably not enough to significantly affect overall risks and outcomes. ¹ Migliorini F, Biagini M, Rath B, Meisen N, Tingart M, Eschweiler J. Total hip arthroplasty: minimally invasive surgery or not? Meta-analysis of clinical trials. Int Orthop. 2019 Jul;43(7):1573-1582. doi: 10.1007/s00264-018-4124-3. Epub 2018 Aug 31. Review. PubMed PMID: 30171273. ^{, 2} Imamura M, Munro NA, Zhu S, Glazener C, Fraser C, Hutchison J, Vale L. Single mini-incision total hip replacement for the management of arthritic disease of the hip: a systematic review and meta-analysis of randomized controlled trials. J Bone Joint Surg Am. 2012 Oct 17;94(20):1897-905. doi: 10.2106/JBJS.K.00495. PubMed PMID: 23079882.

After surgery, patients may spend several hours in a recovery room while the surgical anesthesia wears off. Afterward, a patient is typically taken to a hospital room. The patient may spend 1 to 2 days recovering before discharge, or they may begin immediate physical therapy and be discharged home the same day.

Read about Total Hip Replacement Surgical Procedure