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Dec. 9, 2002

Surgical Procedures Reduce Pain and Recovery Time

Medical University of South Carolina (MUSC) doctors are turning to a new approach to hip and knee replacement surgery which reduces pain and recovery time.

During the past year and a half, MUSC orthopedic surgeons have been increasing their use of minimally invasive surgery. The minimally invasive surgical technique allows a knee or hip
replacement to be inserted through a significantly smaller incision than traditionally made. This results in minimal damage to the muscles and tendons around the knee or hip. And less disruption to the tissue means less pain and weakness and quicker recovery.

With the procedure, the surgeon uses smaller tools and makes smaller incisions to remove damaged bone and cartilage and replace with artificial components. For the hip procedure, either two incisions of about 31⁄2 inches each are made or a single 4-inch incision , as opposed to a 12- to 18-inch incision is made. The incision for a total knee replacement is 4 to 6 inches as compared to 8 to 12 inches.

The surgery is done to ease the pain for patients with osteoarthritis, a degenerative joint disease that often strikes after middle age. The cartilage that cushions the bone gets worn down. Eventually, the bones rub together, causing pain and sometimes compromising the patient's ability to walk. There are approximately 500,000 hip or knee replacement surgeries done annually in the United States. These numbers are expected to increase yearly as the population ages.

"We've increased our focus on minimally invasive surgery during the last year and a half," said H. Del Schutte, M.D., an MUSC orthopedic surgeon who, along with his colleague Harry A. Demos, M.D., performs the procedure at MUSC. "About 30 percent of patients we see are candidates. The minimally invasive procedure works best on patients who are thin, younger and have not had previous surgery."

It is a more difficult procedure for the surgeon, since the smaller the exposure, the more difficult it is to get the components in the right position. "The trick is not to be so less invasive that you compromise the positions of the components and affect the overall results," said Schutte. "Sometimes I start out intending to do the minimally invasive procedure, but because of the patient's anatomy and the severity of the arthritis I could be forced to extend the incision. Our goal is to use the smallest least traumatic approach possible without compromising the final result of the surgery."