By Mr Panos Gikas
Consultant Orthopaedic and Sarcoma Surgeon
Honorary Lecturer, Department of Physics, UCL

Recently there has been an increase in interest in performing hip replacement surgery by less invasive means, and by smaller incisions. Some of these so called minimally invasive techniques however are only reduced skin incision techniques and are associated with the same muscle and/or tendon injury as “conventional” approaches.

AMIS® (Anterior Minimally Invasive Surgery) is a surgical technique used in total hip replacement procedures which follows an inter-muscular and inter-nervous plane to reduce the risk of injury to muscles, tendons, vessels and nerves. By respecting the nerves and because no muscles are cut this aids rapid recovery for patients following surgery

What are the advantages?

  1. DECREASED POST-OPERATIVE PAIN: In comparison with “conventional” surgical techniques, the AMIS approach can reduce the post-operative pain as muscles are not cut.
  2. SHORTER REHABILITATION: Rehabilitation can usually start the day of the operation or the day after. Standing up and walking with arm crutches can start immediately.
  3. SHORTER HOSPITAL STAY: The AMIS® technique usually significantly reduces the duration of hospital stay.
  4. SMALL SKIN SCAR: With AMIS®, the skin incision is often shorter than with “conventional” surgery and therefore scar tissue is reduced.
  5. FASTER RETURN TO DAILY ACTIVITIES:
  6. REDUCED RISK OF DISLOCATION: The preservation of muscles significantly improves the stability of the hip. The risk of dislocation is minimal and the post-operative limitation of movements, usually prescribed in other techniques, is not necessary. The risk of dislocation is reduced because the anterior approach is performed from the front of your body and dislocation is mainly related to posterior hip structure damage.
  7. PREVENTION OF LIMPING: AMIS® is characterised by a surgical technique that protects the various muscles, blood vessels and nerves encountered during exposure of the hip joint. Minimizing muscle and nerve damage reduces the chances of limping.

What are the disadvantages?

With an incision in the front of the thigh, there can be some alteration in the skin sensation over the front and outer aspect of the thigh. This relates to the anatomy of the small nerves that provide sensation to the skin and their proximity to where the surgical incision is made. Over time the area affected by numbness always reduces significantly.

Does it make a difference in the long-term?

The most important factor for the long-term function of a hip replacement is that the hip implants are inserted correctly so as to reconstruct the anatomy of the hip. Beyond the proven early beneficial and faster functional recovery after an anterior approach hip replacement, we do not know if the approach itself makes a significant difference in the longer term.

At the Royal National Orthopaedic Hospital the AMIS Total Hip replacement is being offered by Mr Panos Gikas, who has done a postgraduate fellowship at the University Hospital of Geneva on this approach.

For more information contact please contact the Royal National Orthopaedic Hospital Private Patient Unit:

020 8909 5114

 

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