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I'm doing some research on-line to find out what I can about having a hip replacement. So far, it looks like I should find a surgeon with lots of experience. I know I am going to ask about the surgeon's rate of successes, number of patients who end up having a second surgery, and expectations for recovery and rehab. I'm also looking at differences between the mini-surgery and the full open surgery. What can you tell me about the incision business?

More and more hip replacements are being performed with a mini-incision (less than 10 centimeters or two and a half inches long). Surgeons and patients alike are searching for proof that one approach (mini-incision versus traditional open surgery) is better than the other. To help with these management decisions, a group of researchers from the Health Services Research Unit at the University of Aberdeen in Scotland conducted a very thorough electronic literature search. They searched on-line for any and all studies comparing the results of a mini-incision approach to hip replacement to the results using a standard incision. The studies they found were not all equal in quality or design. For example, the number of subjects ranged anywhere from 20 to 219. In some studies, the surgeon had a great deal of experience performing the minimally invasive procedure. Other studies noted that the cases involved were with surgeons just getting started with this approach and technique. Follow-up varied from six weeks to three years. But outcomes could be compared by looking at amount of blood lost, length of operative time, number of days in the hospital, and complication rate. Complications included dislocations after surgery, level of pain, excessive blood loss, nerve injury, infection, fractures, blood clots, and the need for a second (revision) surgery. These are probably the types of complications and post-op problems you'll want to talk with your surgeon about. Analysis of all the data collected by the Aberdeen group showed that there were small differences in early results. No major differences in outcomes were observed between the two groups. There was less blood loss during the mini-incision procedures and the hospital stay was a day or two shorter. But there were no significant differences between the two groups when looking at complications or revision rates. The authors point out the fact that the available studies were all fairly short-term. So long-term results cannot be compared at this time. Without the benefit of 10 to 20 year studies, it's not clear if the mini-incision approach provides any major advantages over the traditional standard-incision surgery. With more direct marketing to consumers, a greater number of American adults are seeking what is now referred to as "the operation of the century" -- total hip replacement. As consumers making their own informed choices, today's patients need clear evidence, not advertising hype to guide them. And before that can be possible, more high-quality, well-designed studies are needed. At this point all that can be said for sure is there aren't any major differences in short-term results between standard and mini-incision for total hip replacement. The authors of the study summarize it well in a single statement: Current evidence is not strong enough to support one surgical technique over the other.

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