Minimally invasive hip replacement post surgical muscle weakness

Ross A. Hauser, MD. Caring Medical Florida
Danielle R. Steilen-Matias, MMS, PA-C. Caring Medical Florida

Same-Day Hip Replacement Surgery-Minimally invasive hip replacement

While many people are waiting for their hip replacement surgical date, many people are also exploring alternatives to prolonged pain medications and managing along until they get the surgery. Some people are trying to avoid surgery altogether and are exploring non-surgical options. One option many people keep in the “short list,” of their choices is minimally invasive hip replacement. The benefits that is most appealing is a short hospital stay and less complication.

Many people get a great benefit from this surgery. These are typically not the people that we see in our offices. We see the people who may have significantly less hip joint pain, but they have developed another problem. Lack of strength in their buttocks, thighs, and hip and groin area. This is a well-known side effect of hip replacement surgery, whether traditional or minimally invasive.

We also see many people exploring options to an already recommended hip replacement surgery. Before we begin this article and research findings, if you would like to contact our medical team, please use our contact form page. We can help assess your candidacy for our treatments and answer your questions.

How less complicated is a minimally invasive hip replacement? Research from surgeons suggest that the benefit of a smaller incision may be higher complication rates: The surgeons suggest: “proceed with caution”

There is a misconception that minimally invasive hip replacement is a much less dramatic surgery than a traditional hip replacement procedure. We want to let surgeons explain the difference to you. So we begin this article with the reported findings of UK surgeons published in the Annals of the Royal College of Surgeons of England.(1) This is the opinion of the surgeon/authors:

Higher complication rates

Minimally invasive techniques implants may not survive as long as traditional implants

This is our opinion, this is a hip replacement surgery, we agree with the research above, “proceed with caution.”

That study was from 2007. Certainly the techniques have seen improvements, heven’t they? In May 2018, a review paper from the Department of Orthopaedics, University of Utah School of Medicine made these observations on the Direct anterior hip replacement a minimally invasive surgical technique. Simply, the surgeons are making the incisions from the front and you are lying on your back. Why is this minimally invasive? Because if the surgeon comes in from the front, they do not have to detach or cut through muscles typical of side incisions or coming in from the back, with you laying on your stomach during surgery. Cutting through muscles is a problem as we will see below.

Is there potential for nerve damage, fracture risk, revision risk?

So the direct anterior approach total hip arthroplasty approach is better? Here are those observations from the University of Utah team. They were published in the journal Annals of Joint. (2)

As the number of primary total hip arthroplasties (replacements) utilizing the direct anterior approach increases it is important to understand the complications and potential pitfalls of this approach. We review the literature for the learning curve, potential for nerve damage, fracture risk, revision risk, radiation exposure, potential for increased blood loss and wound complications or infection associated with the direct anterior approach. . . Conflicting evidence in the literature makes it difficult to draw conclusions about the anterior approach total hip arthroplasty and increased fracture risk, revision risk or blood loss. ”

“I have to work, I cannot take the time off to rehab a hip replacement, same-day hip replacement sounds right for me.”

The main reason that someone is in our clinic exploring non-surgical treatments for their degenerative hip condition is mostly the same reason they are looking at minimally invasive hip replacement: they cannot take the time off from work to rehab.

The realistic expectation of same-day hip replacement: Same day hip replacement is not right for everyone


Minimally invasive hip replacement – same risks as a standard hip replacement – increased risk in an iatrogenic (surgery causing) nerve palsy (nerve damage/paralysis) during the minimally invasive approach.

Minimally invasive hip replacement can provide benefits over traditional open hip replacement. When the surgery works, it can work very well. But that can be said for open hip replacement surgery as well. The problem is when it does not work that well. Let’s listen to the surgeons.

In the August 2018 edition of International Orthopaedics (3), university medical hospital surgeons in Germany and Italy combined research to publish a study that compared the clinical outcomes of patients who either had a total hip replacement performed via the minimally invasive technique or a standard-invasive total hip replacement.

Both surgeries still presented similar risks:

The surgeons did note that there was an increased risk in an iatrogenic (surgery causing) nerve palsy (nerve damage/paralysis) during the minimally invasive approach.

Study conclusion: “Based on currently available evidence concerning the outcomes following total hip replacement and the analysis of our results, we stated no remarkable benefits of the minimally invasive compared to the standard-invasive surgery.”

“no remarkable benefits of the minimally invasive compared to the standard-invasive surgery.”

In the medical journal Clinical Orthopaedics and Related Research, (4doctors at the Anderson Orthopaedic Research Institute & Inova Center for Joint Replacement at Mount Vernon Hospital, Virginia, and The Rothman Institute & Thomas Jefferson University Hospital, in Philadelphia provided these insights into the same-day hip replacement procedure:

The supportive research findings:

Who is a good candidate for same-day hip replacement?

The researchers then identified who would be a good candidate for the procedure.

What were the results of this study: The researchers then identified the success ratio of the same-day hip replacement procedure.

The researchers found 24% (27 of 112) of patients planning to have same-day release surgery were not able to be discharged the same day. Some had to stay overnight in the hospital.

Is a same-day hip replacement discharge, good or bad?

While many people have concerns about staying in the hospital longer than necessary, here is an interesting survey from doctors who perform same-day hip replacements published in The Journal of Arthroplasty.(5)

Survey results of patients offered same-day release joint replacement:

Recovery and rehabilitation from Same Day Hip Replacement Surgery

All the while there is also physical therapy, visiting nurses, and other home help people.

The side effects of a successful surgery – hip and leg weakness. The problem of post-surgical muscle weakness

We see many people in our offices who did have a successful hip replacement. Successful in that the surgery significantly reduced their hip pain. But the surgery was not as successful as these people hoped. In what way? Some people have an expectation that they will be able to walk out of hospital and all will be well. Muscle weakness and atrophy was not a problem they anticipated.

Here are some of the things we may hear:

Following the surgery, I did not expect to have the back and knee pain that I am having. I am not even going to physical therapy for my hip, I am going for the low back pain and knee pain. I was hoping to get back to work in 4 – 6 weeks, now it is more like 8 weeks at least.

My surgeon told me that I had been walking “funny,” for years as I made adjustments for my hip pain. I totally whacked my gait and natural movements. Fixing this can take months of therapy, maybe up to a year.

In April 2020, in the medical journal Orthopedic reviews (6) a team or orthopedic surgeons reported these findings:

“(We) show lower postoperative pain levels during passive and active physical therapy with the direct anterior approach when compared to the lateral approach (traditional hip replacement) due to less muscle damage. These correlations are valid until 6 postoperative weeks, afterward, we saw no difference between the two groups.”

In other words, if your muscles have not rebounded after 6 weeks post-operation. The muscle saving benefit of minimally invasive surgery is lost.

In our article Why physical therapy and exercise does not help your hip pain and what can help, we go into much more detail about the role of physical therapy before hip replacement. We especially focus on the aspects of why physical therapy may not work for you.

Options that keep your own hip

The purpose of our writing this article is because many people who contact our office are looking for an alternative to traditional total hip replacement. They see possibilities in Prolotherapy and stem cell therapy as a completely non-surgical option.

In the video below, a patient examination is performed and discussed to show who would be a good candidate for Prolotherapy, a non-surgical, in-office procedure.

The benefits of Prolotherapy:

We invite you to continue on with your research at these articles on our site:

In our clinical experience and empirical observation has led us NOT to recommend viscosupplementation for hip osteoarthritis

Platelet Rich Plasma injections and Prolotherapy injections for Gluteus Medius Tendinopathy


This video was created nine years ago. The basic concepts of healing remain the same. We have been treating sports-related injuries with regenerative medicine injections for 26+ years.

In this video, you will see the application of Platelet Rich Plasma injections and the use of Prolotherapy injections. Prolotherapy is the injection of dextrose, or a simple sugar, to irritate damaged hip ligaments. Hip ligaments provide stability, damaged hip ligaments provide INSTABILITY.

The dextrose in the Prolotherapy solution, when injected around the injury, causes a mild inflammatory response, mimicking what the body does naturally in response to soft-tissue injuries. The immune system is drawn to the area of injury and immune cells and platelets release growth factors to build new healthy tissue.  The ligaments and tendons become thicker and stronger from this inflammatory response. Again, this is explained in the video above, and further below.

Are you a candidate for our treatments?

In the video below, Ross Hauser, MD explains the physical examination and shows good and inappropriate candidates for Prolotherapy.

In this video, Ross Hauser, MD demonstrates and describes the Prolotherapy treatment. A summary transcription is below the video.

Do you have a question about hip replacement surgery or need help?
Get help and information from our Caring Medical staff

References

1 Gerrand C, McNulty G, Brewster N, Holland J, McCaskie A. What do patients think about minimally invasive total hip arthroplasty?. The Annals of The Royal College of Surgeons of England. 2007 Oct;89(7):685-8. [Google Scholar]
2 Kagan R, Peters CL, Pelt CE, Anderson MB, Gililland JM. Complications and pitfalls of direct anterior approach total hip arthroplasty. Ann Joint. 2018 May 1;3:37. [Google Scholar]
3 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. International orthopaedics. 2018 Aug 31:1-0. [Google Scholar]
4 Goyal N, Chen AF, Padgett SE, Tan TL, Kheir MM, Hopper RH, Hamilton WG, Hozack WJ. Otto Aufranc Award: A multicenter, randomized study of outpatient versus inpatient total hip arthroplasty. Clinical Orthopaedics and Related Research®. 2017 Feb 1;475(2):364-72. [Google Scholar]
5 Meneghini RM, Ziemba-Davis M. Patient Perceptions Regarding Outpatient Hip and Knee Arthroplasties. The Journal of arthroplasty. 2017 Sep 1;32(9):2701-5. [Google Scholar]
6 Nistor DV, Bota NC, Caterev S, Todor A. Are physical therapy pain levels affected by surgical approach in total hip arthroplasty? A randomized controlled trial. Orthopedic Reviews. 2020 Apr 22;12(1). [Google Scholar]

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