38 • Specialist clinics
Healthcare Innovations • Sunday 26 July 2020
Muscle sparing minimally invasive hip surgery AMIS (anterior minimally invasive surgery) is an innovative surgical technique used in total hip replacement procedures
Tere has been increasing interest in hip replacement surgery being carried out by less invasive means and via smaller incisions. However, some of these so-called minimally inva- sive techniques are merely 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 that 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 not cutting any muscles, the AMIS approach aids rapid recovery for patients following surgery.
What are the advantages? 1. DECREASED POST-OPERATIVE PAIN: In comparison to conven- tional surgical techniques, the AMIS approach can reduce
the
post-operative pain as muscles aren’t cut.
2. SHORTER REHBILITATION TIME: Rehabilitation is much
shorter; patients will start walking on the same day and the majority discharged within 24 hours.
3. SHORTER HOSPITAL STAY: AMIS significantly reduces the length of patients’ hospital stay.
4. SMALLER SKIN SCAR: With the AMIS approach, the skin inci- sion tends to be shorter than that in conventional surgery, and scar tissue is reduced.
5. A FASTER RETURN TO DAILY ACTIVITIES
AMIS is characterised by as a surgical technique that completely preserves all the muscles around the hip joint.
6. A REDUCED RISK OF DISLOCA- TION: Te preservation of muscles significantly improves the stability of the hip. Te risk of dislocation is minimal and the post-operative limitation of movements, usually prescribed in other techniques, isn’t necessary. Te risk of dislo- cation is reduced with the AMIS technique because the anterior approach is performed from the front of the 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. Minimising muscle
T: 020 7824 9364 E:
Panosgikas@icloud.com
hcahealthcare.co.uk/consultants/m/mr-panos-gikas
and nerve damage reduces the chances of limping.
What are the disadvantages? An incision in the front of the thigh can lead to some alteration in the skin sensation over the front and outer aspect of the thigh. Tis relates to the anatomy of the nerves that provide sensation to the skin, and their prox- imity to where the surgical incision is made. Over time, the area affected by numbness reduces significantly and finally returns to normal.
Does it make a long-term difference? Te 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, it isn’t known if the approach itself makes a significant difference in the longer term.
MEET THE EXPERT
Mr Panagiotis Gikas BSc, MBBS (Hons) MBBS (Hons), MD(Res), PhD FRCS (Tr&Orth)
Mr Gikas completed his medical school and postgraduate training in London and further specialized in Australia and Geneva on bone cancer and hip surgery. Mr Gikas’s clinical and research
endeavours have centred around hip and knee reconstruction and the treatment of bone and soft tissue cancer. His interests include the use of the anterior approach to hip replacement and custom- made (bespoke) instruments, as well as the use of robotics for knee replacement, the use of stem cells and cartilage techniques to address cartilage defects and the management of major bone and soft tissue cancer. He has presented on, and published widely on, various aspects of hip, knee and bone cancer surgery, and continues to lead clinical and laboratory research in these fields.
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