2 incision MIS

[Swright]

Okay,

I understand there are risks, but I've read reports on the net that site there risks of 2 incision MIS are no greater than the customary incision.

I've read papers from OS's that strictly perform MIS and have great results.

My OS uses 2 incision MIS with navigational computer assistance. I decided to use him because he is a seasoned OS with lots experience and recommendations. It is really tought to come to a conclusion about which THR bearing you want, let alone who you want to perform the surgery.

I can't find research that is weighted to either side of the 2 incision MIS. It seems the opinions are split. I asked him about the placement and risk because of the limited view. His answer is that using the navigation combined with 22 years of experience the placement is not an issue. I've read about patients who have fractures with regular incisions/saitic nerve damage with regular incisions......so how does someone trust what they read???

 

[Josephine]

Quite! I have frequently said as much since I came on here. Tell you something interesting that has nothing to do with orthopaedics - some years ago, general surgeons started using laparascopes for diagnostic purposes. It was very successful. Then they began doing minor procedures like tubal ligations and they were very successful. Before we knew it, they were removing gall bladders, appendices and later, even doing hysterectomies via laparascopy. And the complication rates for those procedures soared.

There's a side to surgery that is infrequently addressed in all these articles which is that whenever a surgeon changes his method of surgery or uses a new prosthesis, his 'failure' rate goes up while he's adapting. Learning the new procedure takes time - can take a few years even. So while the procedure itself may be okay, it's the skill of the surgeon that makes the crucial difference.

Ergo - a newly qualified surgeon may even have an elevated failure rate on an established procedure until he gets his 'wings' and can go solo - something we have more of a problem with in the UK as these registrars (trainee consultants) do their training on the general patients first with the supervision of the consultant and then solo.

So basically what I'm saying is that it's not usually the technique that produces 'good' results but the technician. And yes, the principle hazard in the posterio-lateral approach is that the sciatic nerve runs right across the surgical field but every surgeon knows about this, indeed, every OR nurse worth his/her salt knows it! It's basic anatomy, so I need not labour the reasons for sciatic nerve damage in that approach.

As for fractures, the second most common hazard is splitting the femoral shaft when preparing it for the prosthesis or even tooling it in an incorrect angle so the tools and/or prosthesis end up perforating the back of the shaft! Again this is a hazard well known by both surgeons and other staff from way back. I remember learning about it when I was a newly qualified staff nurse!! (in - er - 1962 would you believe?!) In both situations the awareness of the risk is the biggest protection against it happening.

So to address your question, I think you will find the same amount of stuff arguing on both sides of such debates. You will never be able to get a conclusion so I wouldn't fret about it too much. In the end it's down to finding a surgeon in whom you feel you have confidence and putting the whole thing in his hands. He, after all, is the expert!