Minimally Invasive Hip Replacement Surgery

(text from NWH website at

More than 300,000 Americans have total hip replacement surgery every year. First performed in 1960, this procedure is considered to be among the most important surgical advances of the past 100 years and has enabled many people to resume the lives they knew before their hip condition had worsened.

Until recently, hip replacement was an open surgery. Today, advancements in technology have resulted in a minimally invasive option that involves small incisions and generally a much shorter recovery period. This new procedure is one of many minimally invasive surgical procedures available at Newton-Wellesley Hospital.

Linda Jancsy, a business analyst at MathWorks in Natick, Massachusetts, is a young and active 50-year-old. Linda suffered from rheumatoid arthritis as a child and developed osteoarthritis as an adult. She started experiencing hip discomfort about five years ago. Like most people with severe joint pain, she tried to relieve her condition through a variety of non-surgical treatments including anti-inflammatory medications and cortisone shots. “I was in excruciating pain,” she states. “It got to the point where I couldn’t exercise or even grocery shop. That’s when I decided it was interfering with my quality of life and that I had to do something about it.”

Ms. Jancsy has had both hips replaced. Her first was through traditional surgery in December 2003. The other, in April 2004, was performed by John Siliski, MD, at Newton-Wellesley Hospital using a new minimally invasive surgical technique.

Comparing the two types of surgery, Jancsy says, “I am so much stronger this time around and was able to resume my daily routine much more quickly. The difference in recovery time with the minimally invasive procedure was overwhelming. Pain was much more manageable and I was able to transition from crutches to a cane a lot sooner than the first time around,” she adds. Her recovery is going so well; Jancsy is already looking forward to lacing up her hiking boots and planning a trip to the White Mountains in New Hampshire.

Traditional hip replacement surgery requires a 10 to 12 inch incision. Muscles, tendons and ligaments are cut in order to access the hip joint. Typically, patients undergoing traditional surgery remain in the hospital for 3 to 5 days. This technique also requires six or more weeks of immediate recovery followed by several months of physical therapy.

In contrast, minimally invasive hip replacement is performed by making one or two small incisions about 1.5 to 2 inches in length. Muscles and tendons are avoided or stretched rather than cut. This procedure results in less blood loss, less tissue trauma, smaller incisions, and less scarring. Patients typically have a hospital stay of only 1 to 2 days, with some patients returning home in less than 24 hours. Recovery is also much faster, allowing patients to return to daily activities much more quickly. However, the technique is not optimal for all patients. Obese patients are generally excluded and candidates must be in overall good health.

Dr. Siliski describes Linda Jancsy as a perfect candidate for the minimally invasive technique. “Linda is young, healthy, and has a very active lifestyle,” he explains. “It was important for her to make a quicker recovery from surgery this time around.”

A number of orthopedic surgeons are performing the newest minimally invasive surgical procedures at Newton-Wellesley Hospital. Daniel Snyder, MD, Alfred Hanmer, MD, Sean Rockett, MD, Henry DeGroot, MD, and Lawrence Geuss, MD, are performing minimally invasive hip surgery as well as minimally invasive knee replacements and minimally invasive rotator cuff repairs with great success for their patients.

When is hip replacement needed?
Arthritis is the most common cause of the disease process that leads to the need for hip replacement. There are several types of arthritis.

• Rheumatoid Arthritis produces chemical changes in the synovial membrane that lines the joint space and causes thickening and inflammation. Cartilage is also destroyed in this process. Other body organs can also be affected. Women are more prone to rheumatoid arthritis than men.

• Post-traumatic Arthritis develops after an injury to the hip joint in which the bone and cartilage do not heal properly. The joint is no longer smooth and irregularities lead to increased wear on joint surfaces.

• Osteoarthritis involves the wearing away of cartilage in the hip joint. As a result, the femoral head and pelvic bone socket begin to rub together, causing pain and stiffness. Osteoarthritis typically occurs in people 50 years of age and older, but can also develop in much younger individuals who have a family history of the disease.

• Avascular Necrosis, a condition in which bone is deprived of its normal blood supply (after organ transplantation or long-term cortisone treatment, for example) can also lead to a need for joint replacement.

Bone and/or joint deformity or a direct injury to the joint can also necessitate hip replacement. In each of these conditions, joint pain can become worse due to people avoiding use of a painful joint. This results in a weakening of muscles, which makes the joint even more difficult to move.

Generally, joint replacement is recommended when:

• Function is limited to the extent that ordinary activities are restricted.

• Pain is severe and not relieved by medication or physical therapy.

• Joint stiffness is significant.

• Diagnostic tests show advanced arthritis or other problems.

While there are multiple conditions leading to joint degeneration, osteoarthristis, generally associated with aging, is the most common. As the American baby-boomer population ages over the next decade hip replacement is expected to increase in frequency.

Orthopedics at Newton-Wellesley Hospital
Orthopedic surgery is one of the largest clinical services at Newton-Wellesley Hospital. Patients of all ages are evaluated and treated by skilled physicians and podiatrists using state-of-the-art technology.

General orthopedists care for virtually all problems of the skeleton from the neck to the feet. Hand surgery specialists at Newton-Wellesley make up one of the largest hand surgery services in New England, providing care for conditions from the elbow to the fingertip.

Newton-Wellesley podiatrists are available to evaluate and treat all foot problems – from arthritis, bunions, hammertoes, and plantar fasciitis to runner’s injuries and diabetic foot problems.

Sports medicine specialists at Newton-Wellesley treat athletes of all ability levels – from youth and “weekend warriors” to professionals. For example, working with the Boston Athletic Association, Newton-Wellesley’s orthopedists and podiatrists provide post-event care for runners of the Boston Marathon.

Orthopedic services are supported by the hospital’s Radiology Department, which uses the most advanced diagnostic equipment available. Orthopedic staff also work closely with Newton-Wellesley’s Rehabilitation Services Department, staffed by physical and occupational therapists as well as rheumatologists and hand therapists.

In collaboration with Massachusetts General Hospital, Newton-Wellesley is also the site for The Spine Center, which offers a multi-disciplinary approach for the diagnosis and treatment of neck and back problems. The Spine Center provides patients with the expertise of leading radiologists, orthopedic and neuro-surgeons, physiatrists (rehabilitation doctors) and physical therapists in one convenient location.

Over the last ten years, numerous orthopedic surgeons throughout the country have contributed to the development of the minimally invasive methods. Many medical centers and several community hospitals now offer these treatments. The procedure does require special training. Newton-Wellesley’s Drs. DeGroot, Geuss, Hanmer, Rockett, Siliski, and Snyder, have received this training, and are performing these procedures successfully at the Newton-Wellesley Hospital.

For more information, or to schedule an appointment, call CareFinder at 1-866-NWH-DOCS (866 694-3627).